- HonorHealth (AZ)
- …it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of health care services ... Degree in Nursing from an accredited NLN/CCNE institution RequiredExperience3 years Registered Nurse in an acute care setting. Required1 year… more
- Hartford HealthCare (Farmington, CT)
- …DRG denial management and appeals preferred. **Licensure, Certification, Registration** * Active Registered Nurse license from the State of Connecticut * ... Denial Specialist is responsible for reviewing, analyzing and appealing denials related to DRG (Diagnostic Related Group) downgrades. This role involves… more
- Carle Health (Urbana, IL)
- …assists the team for timely planning and collaboration. Qualifications Certifications: Licensed Registered Professional Nurse ( RN ) - Illinois Department of ... prior authorizations for swing bed patients, maintain the work ques, and address denials . RMH: make follow up appointments with primary care provider before patient… more
- BayCare Health System (Tampa, FL)
- …**Weekend Requirement:** Occasional + **On Call:** No **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred ACM (Case Management) + ... Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse + Preferred experience in Critical Care or Emergency Service **Benefits:**… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Clinical Documentation Integrity Specialist Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's ... to be named a Forbes "Best Employer" seven times. Position Summary: The CDI Specialist serves as a liaison between the physicians and hospital departments to promote… 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 the necessity, appropriateness, and efficiency of hospital services to… more
- Select Medical (West Orange, NJ)
- …14. Performs other duties as requested. **Qualifications** **Minimum Qualifications** + Licensure as a Registered Nurse or LVN/LPN is required + 2 years of of ... Rehabilitation - West Orange** A Select Medical Hospital West Orange, NJ **Prior Authorization Specialist / Payor Relations Specialist ( RN , LPN )**… more
- TEKsystems (Canoga Park, CA)
- …adjudication. This role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse ( RN ) with hands-on experience in Utilization Management (UM) ... Claims Reviewer Location: West Hills/Canoga Park 91304 Compensation: LVN $38-$40 hourly RN $45-$50 hourly Overview: The Retro Claims Reviewer is responsible for… more
- McLaren Health Care (Mount Pleasant, MI)
- …responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and ... other related duties as required and directed. **Qualifications:** **_Required:_** + Registered Health Information Technician (RHIT), Licensed Practical Nurse … more
- University of Southern California (Arcadia, CA)
- …coding appeals based on documentation, coding guidelines and Coding Clinic for coding denials and/or adjustments. + Extensive knowledge of Medicare Part A and how ... impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review/case management in an acute care facility,… more