- Cottage Health (Goleta, CA)
- Job Description Cottage Health seeks a Utilization Review Manager, Registered Nurse for their Clinical Denials and Appeals department responsible for the ... overall management of utilization review processes and clinical denials between Cottage Health and outside payers. The manager is also responsible for processes… more
- BRISTOL HOSPITAL GROUP (Bristol, CT)
- …Full Time Education Level 4 Year Degree Job Shift 1st Shift (Days) Description Registered Nurse Utilization Reviewer At Bristol Health, we begin each day caring ... inpatient care. Essential Job Functions and Responsibilities: The UM, Registered Nurse role is to provide direct...nurse additionally helps the team to understand the clinical guidelines and criteria sets used to support medical… more
- Arnot Health (Elmira, NY)
- …an approved registered nursing program with a current license as a registered nurse . BSN or Case Management Certification preferred. EXPERIENCE: Three years ... Manager tracks and trends LOS, resource utilization, outliers, readmissions, denials , delay days and satisfaction of the case managed...clinical nursing in acute care hospital setting or two… more
- Riverside Health System (Hampton, VA)
- …Proficiency with computer systems required to perform job Licenses and Certifications Registered Nurse (RN) - Virginia Department of Health Professions (VDHP) ... and facility leadership. Ensures timely notification and communication of pertinent clinical data to support admission, clinical condition, and continued… more
- Guidehouse (Huntsville, AL)
- …None **Clearance Required** **:** None **What You Will Do** **:** The **R** **emote** ** Clinical Denials RN** is responsible for review, analysis and appeal of ... **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:**...clinical denials from insurance companies and third-party payers. This role… more
- Catholic Health Initiatives (Little Rock, AR)
- …State of Arkansas Bachelors Of Nursing Or related healthcare field Minimum three (3) years clinical experience as Registered Nurse (RN) 5 years of RN ... The RN has an integral role within the revenue cycle by providing clinical expertise in the denials management process. The Denials RN performs a root cause… more
- Trinity Health (Hartford, CT)
- …in development of action plans to ensure goals are met **Minimum Qualifications** + Registered Nurse (RN) or Licensed Vocational Nurse / Licensed Practical ... of patient access, revenue cycle and denial management functions; technical and clinical denials areas, such as medical necessity, eligibility issues, no… more
- Children's Mercy Kansas City (Kansas City, MO)
- …per contracts for medically appropriate level of care. Manages concurrent clinical denials through completion of verbal reconsideration process. Works ... children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes ...+ One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon… more
- Texas A&M University System (College Station, TX)
- Job Title Registered Nurse II - Prior Authorization & Referral Agency Texas A&M University Health Science Center Department University Health Services Proposed ... and team-based health care delivery. What we want The Registered Nurse II-Prior Authorization and Referral, under...are denied. + Collaborate with providers to gather necessary clinical documentation and address denials or escalations.… more
- UPMC (Pittsburgh, PA)
- …retrospective appeal process for acute inpatient clinical denials and audits. The Clinical Review Nurse also serves as a clinical resource person for ... your career? UPMC is hiring a full-time Revenue Cycle Clinical Review Nurse . This position works Monday...Word and Microsoft Excel. **Licensure, Certifications, and Clearances:** + Registered Nurse (RN) + Act 34 *Current… more
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