• Clinical Utilization Review Specialist

    Community Health Systems (Franklin, TN)
    …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
    Community Health Systems (09/03/25)
    - Related Jobs
  • Utilization Review Clinician

    Monte Nido (Miami, FL)
    …in level of care, discharge, retrospective, facilitating peer to peer reviews, and written appeals . + Engage in clinical rounds as an active treatment team ... team approach while integrating state-of-the-art medical, psychiatric, nutritional, and clinical strategies to provide comprehensive care within an intimate home… more
    Monte Nido (09/06/25)
    - Related Jobs
  • Clinical Denials Specialist

    UHS (Binghamton, NY)
    …(5) years of experience in acute/tertiary facility. + Minimum Required: NYS Licensed Registered Nurse Preferred: + Bachelor's of Science in Nursing with three ... Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this vital role,… more
    UHS (09/09/25)
    - Related Jobs
  • RN Utilization Review - System Care…

    Guthrie (Binghamton, NY)
    …to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . Assesses and coordinates discharge planning needs with ... Gastroenterology and Pulmonary Critical Care Fellowship programs. Guthrie is also a clinical campus for the Geisinger Commonwealth School of Medicine. more
    Guthrie (07/05/25)
    - Related Jobs
  • Manager - Utilization Review & Denials Management

    Beth Israel Lahey Health (Plymouth, MA)
    …and determines appropriate strategy in response to reimbursement denials. + Responsible for appeals and follow up on clinical denials escalated through a work ... queue, providing appropriate response supported by clinical information. + Provides oversight of the appeals process and direction regarding appeals and… more
    Beth Israel Lahey Health (07/29/25)
    - Related Jobs
  • Nurse Supervisor

    State of Colorado (Sterling, CO)
    …Rights MINIMUM QUALIFICATIONS: + Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of Nursing or any state ... III 30492 09/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 09/09/2025 Closing Date...years of full-time experience providing patient care as a Registered Nurse . W ork experience less than… more
    State of Colorado (09/10/25)
    - Related Jobs
  • Nurse I - Veterans Community Living Center…

    State of Colorado (Garfield County, CO)
    …night shifts to include holiday & weekends as needed? + Must possess a valid Registered Nurse License ( RN ) from the Colorado Department of Regulatory ... of Employment & Appeal Rights Education/Licensure/Certification/Experience: Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing or… more
    State of Colorado (07/17/25)
    - Related Jobs
  • Utilization Management Manager (Hybrid)

    CareFirst (Baltimore, MD)
    …+ Proficient in Microsoft Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\ RN - Registered Nurse - State Licensure and/or ... authorization of services and approved claims. + Prepares retrospective reviews, case appeals , billing coordination, and clinical support. + Manages the analysis… more
    CareFirst (07/12/25)
    - Related Jobs
  • Case Manager I - Sharp Memorial Hospital -FT…

    Sharp HealthCare (San Diego, CA)
    …**Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...will participate in venues to reduce barriers to discharge.The RN CM I Collaborates with Clinical Resource… more
    Sharp HealthCare (09/10/25)
    - Related Jobs
  • Quality Manager

    Eastern Connecticut Health Network (Vernon, CT)
    …or doctorate degree. + Possession of a current license to practice as a registered nurse or as a physical/occupational therapist in the state of Connecticut. ... Why consider applying to Visiting Nurse & Health Services of CT? Here are...supervises Clinical Documentation Specialists as well as Clinical Support Specialists. EDUCATION/CERTIFICATION: + RN degree… more
    Eastern Connecticut Health Network (09/05/25)
    - Related Jobs