- Sharp HealthCare (La Mesa, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA...advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with… more
- St. Peters Health (Helena, MT)
- …improvement and observance of quality indicators to support admission status. 16. Evaluate denials for appropriateness for appeals versus billing at an alternate ... providers is an essential requirement for this role. EDUCATION: * Clinical preparation; RN required LICENSE/CERTIFICATION/REGISTRY: Nursing licensure in the… more
- Catholic Health Services (West Islip, NY)
- …degree required. + Master of Science degree strongly preferred. + Licensure: New York Registered Nurse ( RN ) License & Registration. + Certification: Care ... not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure… more
- 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...This role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with… more
- University of Southern California (Arcadia, CA)
- …mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials , and appeals . + Collaborates and communicates with multidisciplinary team ... with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost.... Licenses and Certifications Minimum (Required) * A current RN licensure in the State of California is required.… more
- UnityPoint Health (Cedar Rapids, IA)
- …of health care resources, provision of high-quality health care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides ... UM spcialist will also be called upon to provide clinical and nursing expertise and support within the HOD...to quality care, effective utilization of resources and pursues denials of payment and referrals in a timely, legible… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the… more
- Sharp HealthCare (San Diego, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with… more
- University of Southern California (Arcadia, CA)
- …requirements impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review/case management in ... recommendations on query structure, process, and workflow. Responds to coding denials with clinical justifications and coding conventions. Maintain… more
- Trinity Health (Nampa, ID)
- …needed and requested by third party payers and Medicaid. + Responsible for appeals , denials , as appropriate. Utilizes physician advisor referral as appropriate. ... quality of care. We are looking to hire a ** Clinical Resource Manager** for our Medical Center in Nampa,...teams. **General Requirements:** + Colleague must have an RN license, as defined by their primary work state… more