- SUNSHINE ENTERPRISE USA LLC (Orange, CA)
- …of the position such as those listed above is also qualifying. Preferred Qualifications Active Registered Nurse ( RN ) license to practice in the state of ... Job Description Grievance & Appeals Nurse Specialist At Sunshine Enterprise...clinical issues. Managed care and health care industries. Appeals and grievance processes. At Sunshine Enterprise USA LLC,… more
- MedStar Health (Baltimore, MD)
- …and 1-2 years 2 years background/experience in hospital audits preferred Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact ... of Position Responsible for coordinating and monitoring the denial management and appeals process. Combines clinical , business and regulatory knowledge and skill… more
- Children's Mercy KC (Kansas City, MO)
- …or demonstrated leadership skills in a previous role One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon ... administrative processes and data related to medical necessity denials, clinical appeals , long length of stay rounds,...hire One of the following: Licensed RN - Kansas, Registered Nurse … more
- Corewell Health (Royal Oak, MI)
- …experience in care management, utilization review, home care and/or discharge planning. Preferred Registered Nurse ( RN ) - State of Michigan License Upon ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …an 18 month commitment before posting for other internal positions. Job Qualifications License Registered Nurse ( RN ) with active license in the state of ... Review Manager - The BlueAdvantage Inpatient Utilization Management department is looking for an RN with at least 3 years of clinical experience to join our… more
- Franciscan Missionaries of Our Lady Health System (Baton Rouge, LA)
- …Graduated from an accredited school of nursing ADN or BSN Licensure: Registered Nurse (Active Louisiana, Mississippi, multistate/compact or APRN) required ... and organizational requirements. Other Duties as assigned 10% a. Initiates formal Appeals on any Denial for Inpatient Setting when indicated. b. When requested,… more
- Public Health Trust of Dade Co (Miami, FL)
- Associate Nurse Manager, Organ Placement & Preservation, Miami Transplant Institute, Full Time, 12-Hour Shifts, Nights, rotating weekends Department: Jackson's Miami ... in terms of patient outcomes. Job Summary: The Associate Nurse Manager reports directly to the Nurse ...high quality, safe and appropriate nursing care, competency of clinical and support staff, and appropriate resource and service… more
- Children's Mercy KC (Kansas City, MO)
- …Management, Utilization Review, and Performance Improvement Leadership One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri ... payers, patients, and coworkers. Utilizes knowledge of hospital processes, clinical patient care, state and federal regulations and payer...required upon hire One of the following: Licensed RN - Kansas, Registered Nurse … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound ... an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will...to assist with medical necessity determinations. Key Qualifications: + Registered Nurse with an active unrestricted professional… more
- Molina Healthcare (Midvale, UT)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** _For this position we are seeking a ( RN ) Registered Nurse who must...with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate… more
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