- Molina Healthcare (Midvale, UT)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... _For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate… more
- Guidehouse (Huntsville, AL)
- **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The **R** **emote** ... expected outcomes daily + Familiarity with medical records assembly & clinical terminology, coding terminology additionally beneficial + Personal responsibility,… more
- St. Luke's University Health Network (Allentown, PA)
- …and/or formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents ... patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient...and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals… more
- Trinity Health (Hartford, CT)
- …Type:** Full time **Shift:** Day Shift **Description:** **Position Purpose** The Clinical Pre-Service Nurse Coordinator is directly responsible for reviewing ... trends to remediate issues and assist with internal process improvement. Leverages clinical knowledge and standard procedures to ensure timely attention to denials… more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** + Thoroughly investigate clinical appeals and complaints/grievances utilizing appropriate internal ... support of a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals , document… more
- US Tech Solutions (Columbia, SC)
- …+ NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral Health or infusion therapy ... line of business. Previous Medicare experience and /or UR experience/Process Appeals requests/can have experience in either Utilization management or Appeals… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …defense, LifeNet and special focus audits and reports findings. + Serves as a clinical resource for coding / denial management and customer service issues. + ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and...supporting documentation, as well as facilitates the completion of appeals in a timely manner. + Prepares trend and… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a **Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale AFB, ... accordance with References (e) and (o). After following the directed methodology for appeals , the MTF will also adhere to its respective Service or joint commands'… more
- Hartford HealthCare (Farmington, CT)
- …Coding management for discussion and plans for dissemination to providers, clinical documentation specialists (CDS), and coding professionals. . Facilitates ... other specialty reviews. This position also supports denials and appeals specialists as a subject matter expert (SME) and...coding professionals. . Presents on topics related to clinical documentation integrity in all care settings to all… more
- Nuvance Health (Danbury, CT)
- …and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering with local case ... appeals specialists to meticulously investigate denied claims, prepare comprehensive appeals , and collaborate with clinical staff to ensure successful… more
Recent Searches
- materials logistics leader (United States)
- manufacturing positions (United States)
- Field Services Representative (Arizona)
- Addiction Counselor (New York)
Recent Jobs
-
Operations Program Manager - Space Payloads
- L3Harris (Wilmington, MA)
-
Vice President, Studio and Content Finance Solutions
- NBC Universal (Universal City, CA)
-
Orthopedic Technician Medical Assistant
- Dignity Health (Phoenix, AZ)
-
Assistant/Associate Professor - Marketing & Supply Chain Management
- Texas Tech University (TX)