• Denials Management Nurse

    Catholic Health Initiatives (Little Rock, AR)
    …as Registered Nurse (RN) 5 years of RN experience **Preferred** Denials management experience Previous case management , utilization management ... an integral role within the revenue cycle by providing clinical expertise in the denials management process. The Denials RN performs a root cause analysis of… more
    Catholic Health Initiatives (07/03/25)
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  • Registered Nurse or Physical Therapist…

    CenterWell (Honolulu, HI)
    …a part of our caring community and help us put health first** The ** Denials Management Specialist** is responsible to respond to, monitor and analyze all ... not limited to ADR's, CERTS, RAC's, ZPIC's, SMRC's, and all other revenue-driven denials and requests. Guides and coordinates with the branch staff in developing… more
    CenterWell (07/30/25)
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  • 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 clinical ... and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
    Houston Methodist (07/31/25)
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  • Registered Nurse (RN) - Utilization…

    Rochester Regional Health (Rochester, NY)
    …as needed. Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a resource on denial ... Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester...- Friday, Days SUMMARY: Review all inpatient medical necessity denials for the health system based on InterQual and/or… more
    Rochester Regional Health (08/02/25)
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  • High Risk Nurse Care Manager

    Children's Mercy Kansas City (Kansas City, MO)
    …lives of children beyond the walls of our hospital. Overview The High-Risk Nurse Lead manages high risk administrative processes and data related to medical ... necessity denials , clinical appeals, long length of stay rounds, and...for the patient population, hospital, care delivery model, care management practices, and payer contracting. Supports facilitation and tracking… more
    Children's Mercy Kansas City (06/18/25)
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  • Utilization Review Nurse - Case…

    Houston Methodist (The Woodlands, TX)
    …manager, denials , and pre-bill team members, as well as management . **PEOPLE ESSENTIAL FUNCTIONS** + Establishes and maintains effective professional working ... At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered...determinations (LCDs & NCDs). This position collaborates with case management in the development and implementation of the plan… more
    Houston Methodist (07/12/25)
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  • Clinical Review Nurse Care Manager

    Children's Mercy Kansas City (Kansas City, MO)
    …beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance knowledge, ... contracts for medically appropriate level of care. Manages concurrent clinical denials through completion of verbal reconsideration process. Works with physicians… more
    Children's Mercy Kansas City (06/18/25)
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  • Revenue Integrity - Nurse Auditor

    Trinity Health (Ann Arbor, MI)
    **Employment Type:** Full time **Shift:** **Description:** Responsible for coordinating denials with Patient Business Service (PBS) center and ensures compliant and ... complete clinical documentation, assists with denials and related audits, and identifies opportunities for revenue optimization. Investigates denials and root… more
    Trinity Health (07/11/25)
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  • Registered Nurse - Utilization…

    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 ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
    ERP International (06/18/25)
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  • Care Manager ( Registered Nurse / RN )

    Catholic Health Services (Bethpage, NY)
    …in Nursing (BSN) degree strongly preferred Licensure: New York Registered Nurse (RN) License & RegistrationCertification: Case Management Certification ... Managers will: Educate staff, physicians, patients, and families in the case management process. Review new admissions and continued stay patients to determine… more
    Catholic Health Services (07/23/25)
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