- Texas Health Resources (Bedford, TX)
- …management growth inclusive of supervisory and leadership experience Required Licenses and Certifications RN - Registered Nurse Upon Hire Required Or LMSW ... management. Directs the activities of the Care Transition Managers ( RN & SW). Serves as a content expert on...data (eg, LOS data, avoidable days, adverse determinations, and denials / appeals ) and makes recommendations to improve performance.… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …duties as assigned. + LICENSES AND/OR CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid Compact ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and...supporting documentation, as well as facilitates the completion of appeals in a timely manner. + Prepares trend and… more
- Houston Methodist (Houston, TX)
- …leading multi-site or enterprise-level programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... integration and advancement of a unified case management model grounded in clinical excellence, throughput efficiency, care transitions, and denials prevention.… more
- Presbyterian Homes and Services (Roseville, MN)
- …communicate at IDT + Site specific education + Key measure management Qualifications + Registered nurse with current licensure from the State Board of Nursing in ... Director reports directly to the Direct of Care Center Clinical Services or designee. The Lead RAI Director supervises...Auditing RUG grouper/MDS end splits + Reviewing all expedited appeals and ALJ level appeals + Monthly… more
- NHS Management, LLC (Tuscaloosa, AL)
- …in accordance with the assessment and the plan of care. QUALIFICATIONS + Must be a Registered Nurse in good standing in the state(s) in which assigned + Must be ... experience required. RAC certified highly desired! Are you a RN with at least one year of MDS Coordinator...and Rehabilitation in gathering information for Medicare and Medicaid appeals and denials as requested. + During… more
- Sanford Health (Rapid City, SD)
- …experience preferred. Experience in medical necessity review preferred. Currently holds an unencumbered registered nurse ( RN ) license with the State Board of ... improvement, and interaction with payers. Additional duties include management of medical denials , appeals , and grievances. Understand and provide insight into… more
- Henry Ford Health System (Detroit, MI)
- …role is responsible for overseeing pre- and post-payment audit processes, managing denials and appeals , and driving payer behavior change through data-driven ... for pre- and post-payment audit processes. This is more than managing denials -it's about driving payer behavior change, leveraging data to influence outcomes, and… more
- CaroMont Health (Gastonia, NC)
- …Care Management and Senior management as necessary. Retrospectively reviews medical record for clinical denials . Composes a detailed summary of care and sends ... activity and appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process. The UR Specialist… more
- Guthrie (Binghamton, NY)
- …needed for patient that have arrived without orders. Prepare educational materials for the RN Nurse Navigator for Chemo Education Visits per the instruction and ... of coverage of ordered medications. + Coordinate and complete appeals for denials as needed + Monitor...offices and for DBL office as needed Coverage for RN Nurse Navigator + Coordinate and facilitate… more
- BriteLife Recovery (Englewood, NJ)
- …and continued stay authorizations from insurance payers by effectively communicating clinical information and advocating for appropriate levels of care. The UR ... Specialist works closely with clinical staff, admissions, medical providers, and third-party payers to support patient access to treatment and maintain financial… more