• RN - Denial Reviewer

    PeaceHealth (Vancouver, WA)
    **Description** PeaceHealth is seeking a RN Denial Reviewer for a Full Time, 1.00 FTE, Day position. The salary range for this job opening at PeaceHealth is ... to payers. Provides support in development of the clinical denial process, letter templates, and process improvements. Ideal candidate...in the inpatient acute care setting Credentials + Required: Registered Nurse In state of practice or… more
    PeaceHealth (03/12/25)
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  • Denial Resource Center RN (Hybrid…

    Baylor Scott & White Health (Dallas, TX)
    …impact by taking initiative and delivering exceptional experience. **Job Summary** You, as a Registered Nurse in the Denial Resource Center at Baylor Scott ... the payer (Insurance) side of appeals and denials. + Experience in Utilization Review and Case Management. **Essential Functions of the Role** + You receive rejected… more
    Baylor Scott & White Health (03/09/25)
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  • Registered Nurse ( RN )…

    Dartmouth Health (Lebanon, NH)
    …communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote :Fully Remote * Area ... Overview Utilization Review - RN Per Diem, Fully Remote Works...of inpatient denials, including, but not limited to, reviewing denial letters, collaborating with the Medical Director and appropriate… more
    Dartmouth Health (03/15/25)
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  • Clinical Reviewer Utilization Management…

    US Tech Solutions (Canton, MA)
    …required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected to function independently in her / ... **Job Description** **Location: Remote ** **Duration: 4 months contract (with possible extension)**...the job** + Bachelor's degree in Nursing, preferred + Registered Nurse with current a and unrestricted… more
    US Tech Solutions (03/06/25)
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  • Clinical Utilization Reviewer , LPN

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …products and benefits, as well as regulatory and NCQA requirements. + Refer to RN or PT Clinical Utilization reviewer for more complex cases as appropriate ... of services is identified. + Refer to Physician Review Unit (PRU) for potential denial of...Mobile, and Resident personas. This position can be fully remote , with expectations to work in our Hingham, MA… more
    Blue Cross Blue Shield of Massachusetts (02/25/25)
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  • Clinical Documentation and Denial

    CaroMont Health (Gastonia, NC)
    …addition, the following are essential duties and responsibilities of the CDS and Denial Specialist: Review patient medical records and utilize clinical and ... Job Summary: The Clinical Documentation and Denial Specialist will assist with development and execution...with the best clinical outcomes possible. Provide physician and nurse education to achieve compliance with best practice and… more
    CaroMont Health (02/21/25)
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  • Denials Management RN Specialist…

    AdventHealth (Altamonte Springs, FL)
    …2 years utilizing InterQual and/or MCG . Minimum of three (3) years' experience as Registered Nurse ( RN ) in an acute clinical setting . Clinical experience ... even better. **Shift** : Full-time; Monday-Friday **Job Location** : Remote **The role you will contribute:** This position is...or decision regarding other action. . Various types of denial review , appeal, further action which includes… more
    AdventHealth (01/27/25)
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  • Clinical Appeals Nurse ( RN ): Texas…

    Molina Healthcare (Omaha, NE)
    …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of previously denied ... interpret these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Compact… more
    Molina Healthcare (02/09/25)
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  • RN Case Manager, Inpatient

    Memorial Sloan-Kettering Cancer Center (New York, NY)
    …appeals and acquire authorizations for treatment Key Qualifications: + Current NYS Registered Nurse License/Registration and BSN preferred + At least 2-3 ... mission at MSK and around the globe. Job Description RN Case Manager, Inpatient | New York, NY Exciting...The MSK Case Management Department is made up of Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and support… more
    Memorial Sloan-Kettering Cancer Center (03/04/25)
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  • Case Manager - Case Management

    Arnot Health (Elmira, NY)
    … Management meetings EDUCATION: RN required. EXPERIENCE: NYS licensed Registered Nurse required. Bachelor's in nursing preferred. Must have proficient ... Job Description Remote work available! Up to $10,000 Sign on...physicians and other Arnot Health departments in matters of auth/ denial review decisions. 8. Maintains a working… more
    Arnot Health (02/06/25)
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