- Beth Israel Lahey Health (Milton, MA)
- …other related duties as required and directed. Qualifications: Required . Licensure as a Registered Nurse ( RN ), Massachusetts . Three years of recent ... lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission… more
- St. Luke's University Health Network (Allentown, PA)
- …near vision, visual monotony. EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state ... utilization management required. Prefer financial experience related to appeal processes with insurance providers. Demonstrated experience relating to all types… more
- Trinity Health (Farmington Hills, MI)
- …**MINIMUM QUALIFICATIONS** Must possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate of an accredited school of ... across the various impacted departments + Coordinates rejection, denial and appeal activities with Ministry Organization (MO) based Utilization Review/Case… more
- Northwell Health (Melville, NY)
- …five (5) years of job entry date. + Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as ... care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. Performs concurrent and retrospective utilization… more
- HonorHealth (Scottsdale, AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... 1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse ( RN ) State And/Or Compact State Licensure Required more
- 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 ... and bring about the best opportunity for fair reimbursement. The Clinical Denial Management Specialist will adhere to the AHS Compliance Plan and to all rules and… more
- Ochsner Health (New Orleans, LA)
- …in Appeal /Denial Management **Certifications** Required - Current State of Louisiana Registered Nurse ( RN ) License Preferred - Certification in Case ... relates to all medical necessity audits. **Education** Required - Registered Nurse Diploma Preferred - Associate's or...experience in the delivery of patient care as an RN . Experience in Case Management, Utilization Review… more
- Baptist Memorial (Memphis, TN)
- …prior to initial appeal action in order to optimize reimbursement and utilization of resources. + Prepares response to appeal /request for information based ... for acute care inpatient Part A services to determine appeal action. Reports to the manager of the Denial...+ Employee referral program Job Summary: Position: 3484 - Specialist -Denial II RN Facility: BMHCC Corporate Office… more
- Healthfirst (NY)
- …Termination, and Suspension of services. The end to end process requires the Specialist to independently: + Research issues + Quality of Care Experience + Reference ... a framework that measures productivity and quality for each Specialist against expectations + Prepare cases for Medical Director...cases for Maximus Federal Services, Fair Hearing, and External Appeal through all levels of the appeal … more
- Ascension Health (Baltimore, MD)
- …process. + Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + ... **Details** + **Department:** Utilization Management + **Schedule:** On-site, Monday-Friday, 8:00AM-4:30PM. Must...location, qualifications and comparison with associates in similar roles_ ** Registered Nurse , Certified Case Manager (CCM, ACM,… more