• Denials Management Specialist

    St. Luke's University Health Network (Allentown, PA)
    …communities we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party ... JOB DUTIES AND RESPONSIBILITIES: + Reviews all Inpatient Retroactive Denials in the Denials Management ...an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
    St. Luke's University Health Network (05/14/25)
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  • Registered Nurse or Physical…

    CenterWell (Honolulu, HI)
    **Become a part of our caring community and help us put health first** The ** Denials Management Specialist ** is responsible to respond to, monitor and ... or requested. **Use your skills to make an impact** **Required Experience/Skills:** + Registered Nurse or Physical Therapist. + Current state license as a… more
    CenterWell (07/30/25)
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  • Registered Nurse RN Case…

    AdventHealth (La Grange, IL)
    …resolution skills . Teamwork principles **EDUCATION AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse ( RN ) . ... **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . State of Illinois registered nurse license **LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:**… more
    AdventHealth (05/31/25)
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  • Registered Nurse RN Care…

    AdventHealth (Hinsdale, IL)
    …Planning + Conflict management and resolution skills + Teamwork principles + Registered Nurse ( RN ) Required + Certified Case Manager (CCM) Preferred ... transitions, patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the… more
    AdventHealth (07/01/25)
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  • Utilization Review Specialist RN

    Houston Methodist (Sugar Land, TX)
    …includes three years in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered ...functions through point of entry, observation progression of care management , concurrent review and denials reviews. Additionally,… more
    Houston Methodist (07/29/25)
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  • Specialist -Denial II RN

    Baptist Memorial (Memphis, TN)
    Overview Specialist -Denial Mitigation II RN Job Code: 21432 FLSA Status Job Family: FINANCE Job Summary * Position may be filled in Memphis, TN; Jackson , MS The ... Denial Mitigation-Appeal Specialist II RN serves in a key...along to healthcare insurance providers in response to post-claim denials received by BMHCC. Physician Advisor communication may be… more
    Baptist Memorial (07/11/25)
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  • RN Clinical Review Appeals…

    St. Luke's University Health Network (Allentown, PA)
    …Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. . ... a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews...and procedure code assignment and MS-DRG/APR-DRG accuracy based on denials or audit findings from government and commercial payers.… more
    St. Luke's University Health Network (07/08/25)
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  • RN Utilization Review Specialist Per…

    HonorHealth (AZ)
    …1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse ( RN ) State And/Or Compact State Licensure Required ... more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of...from an accredited NLN/CCNE institution Required Experience 3 years Registered Nurse in an acute care setting.… more
    HonorHealth (06/11/25)
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  • Clinical Authorization Specialist

    Dana-Farber Cancer Institute (Brookline, MA)
    …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... molecular pathology, high-cost drug, and off-label drug authorizations. The Clinical Authorization Specialist is also responsible for managing denials related to… more
    Dana-Farber Cancer Institute (07/01/25)
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  • DRG Specialist

    UPMC (Pittsburgh, PA)
    … Health Information Administrator OR Registered Health Information Technician (RHIT) OR Registered Nurse ( RN ) + Act 34 *Current licensure either in ... UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our... (CCS) OR Certified Professional Coder (CPC) OR Certified Registered Nurse Practitioner OR Doctor of Medicine… more
    UPMC (06/11/25)
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