- 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 clinical appeals… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical… 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 management ... BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive experience in utilization review,… more
- 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. ... vision for healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health...Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials … more
- Nuvance Health (Danbury, CT)
- …Days, Evenings, Nights available* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...* Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of… more
- Avera (Sioux Falls, SD)
- …cause undue hardship to the employer. **Required Education, License/Certification, or Work Experience:** + Registered Nurse ( RN ) - Board of Nursing An active ... payer Peer-to-Peer appeals for commercial/managed care payer admission/concurrent level of care denials . + Collaborates with the Clinical Appeals Specialist to… more
- 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 ... the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first...preferred. + **LICENSURE/REGISTRATION/CERTIFICATION** + Licensed to practice as a Registered Nurse in the state of North… more
- 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...RHIA - Registered Health Information Administrator required or + CDIP -… more
- Nuvance Health (Danbury, CT)
- …retrospective denials , documents appropriately and routes to Denial Prevention RN in a timely manner. 12. Communicates with insurance companies to schedule ... quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors (PAs) and other stakeholders in...to appeals, denial and clinical reviews 9. Reviews new denials and appeal upheld cases in work queue and… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively conducts point ... years in utilization review and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact… more
