• Senior Denials Mgmt Specialist

    Houston Methodist (Sugar Land, TX)
    At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the ... and denials for no authorization. The Senior Denials Management Specialist position communicates...nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
    Houston Methodist (10/29/25)
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  • RN Clinical Denials Appeals…

    CommonSpirit Health (Centennial, CO)
    …who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites with external ... BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive experience in utilization review,… more
    CommonSpirit Health (11/15/25)
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  • Clinical Denials Prevention & Appeals…

    Nuvance Health (Danbury, CT)
    …and trending all appeals and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care contracting team ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting… more
    Nuvance Health (09/25/25)
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  • Denials Prevention Specialist

    Datavant (Nashville, TN)
    …Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing for inpatient admission. ... by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing… more
    Datavant (11/12/25)
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  • Utilization Review Denials Nurse

    UNC Health Care (Kinston, NC)
    …preferred. + **EXPERIENCE** + Minimum 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review, care management , ... or compliance experience preferred. + Minimum 1 year clinical denials management preferred. + **LICENSURE/REGISTRATION/CERTIFICATION** + Licensed to practice as… more
    UNC Health Care (11/20/25)
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  • DRG Denials Auditor

    Community Health Systems (Franklin, TN)
    …+ CRNP, LPN, RN , MD, PA, or DO preferred + CCS-Certified Coding Specialist required or + RHIT - Registered Health Information Technician required or + ... **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits...Medical Coding Program preferred + Associate Degree Health Information Management or related field preferred + 3-5 years Inpatient… more
    Community Health Systems (09/09/25)
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  • Clinical Government Audit Analyst and Appeal…

    Stanford Health Care (Palo Alto, CA)
    …180 Days or + CCDS - Cert Clinical Document Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred ... **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical role in the Revenue...II plays a critical role in the Revenue Cycle Denials Management Department by managing and resolving… more
    Stanford Health Care (11/14/25)
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  • Utilization Review Specialist Nurse

    Houston Methodist (Houston, TX)
    …in utilization review and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact ... 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 (11/02/25)
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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 (10/28/25)
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  • RN Utilization Review Specialist Per…

    HonorHealth (AZ)
    …in an acute care setting. Required1 year experience in UR/UM or Case Management RequiredLicenses and CertificationsRegistered Nurse ( RN ) State And/Or Compact ... it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of health care services… more
    HonorHealth (11/04/25)
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