- BroadPath Healthcare Solutions (Tucson, AZ)
- …BroadPath is seeking a highly motivated and results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical ... directors/physician reviewers, network physicians, and network facilities to ensure consistent clinical evaluation and processing of medical necessity appeals .… more
- NewYork-Presbyterian (Brooklyn, NY)
- …an average of 60-70 medical/surgical daily admissions that requires risk identification and clinical reviews. A utilization nurse completes no less than 20 ... are listed in the following description. Case Manager - RN - Inpatient Units- Brooklyn Methodist - Days Located...inpatient criteria or continued inpatient stay - Coordinating expedited appeals for inpatient denials with attending physicians… more
- CommonSpirit Health (Centennial, CO)
- …with resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue ... Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse...must be in CO, UT, or Kansas.** Must have Clinical Denials experience. Please make sure it's… more
- Nuvance Health (Danbury, CT)
- …delays in reimbursement. This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to all payers, ... *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are...initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD… more
- Highmark Health (Pittsburgh, PA)
- …all regulatory and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials / appeals and retrospective payer audit ... :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the...clinical nursing role + Current State of PA RN licensure OR Current multi-state licensure through the enhanced… more
- McLaren Health Care (Mount Pleasant, MI)
- …of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and ... education sessions to maintain competency and knowledge of regulations in denials , utilization management, care management, clinical documentation, and… more
- Children's Mercy Kansas City (Kansas City, MO)
- …necessity review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials / appeals oversight. Participates in department and ... experience + Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + One… more
- Nuvance Health (Danbury, CT)
- …communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in work ... 5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
Recent Jobs
-
Principal Software Engineer
- RTX Corporation (Colorado Springs, CO)
-
Information Technology Customer Support Specialist
- KBR (Bethesda, MD)
-
SR Cloud Engineer
- General Dynamics Information Technology (Durham, NC)
-
Associate Director, Biostatistics
- Otsuka America Pharmaceutical Inc. (Salem, OR)