- UNC Health Care (Kinston, NC)
- …to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying ... the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first...a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Nuvance Health (Danbury, CT)
- …the time of review . If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. * Coordinate with the care team in changing patient ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care… more
- Datavant (Nashville, TN)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials ...letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +… 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 of ... this position is able to cover a multitude of utilization review functions through point of entry,...point of entry, observation progression of care management, concurrent review and denials reviews. Additionally, the URSN… more
- CommonSpirit Health (Centennial, CO)
- …as a Registered Nurse . 3 years with progressive experience in utilization review , preferred. Prior experience writing clinical denial appeal letters ... indicated through research and coordination of completion of medical records and utilization review processes. Identifies areas for documentation and/or process… more
- CDPHP (Latham, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... determinations and appropriate exceptions, coordinating with Medical Directors on denials . In addition, the UR nurse is...of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization… more
- Cognizant (Annapolis, MD)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in… more
- Beth Israel Lahey Health (Plymouth, MA)
- …care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Part-Time Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
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