team, and The Power of Every One. Job Title Concurrent Denial Nurse BU Location Cleveland Facility Remote Location... world. As a Concurrent Denial Nurse, you will support the Utilization Management Department by reviewing concurrent...
for expected reimbursement. Evaluates denials and non-certified days from 3rd party payors to determine appropriateness of denial... Acute/Critical Care Nursing (Adult, Pediatric & Neonatal). MCG. ABMCM Certified Managed Care Nurse. ACMA Case Management...
Job Category: Finance Job Description: Inova Health is looking for a dedicated Registered Nurse (RN) Clinical... work schedules, and remote and hybrid career opportunities. Registered Nurse (RN) Clinical Documentation Denials Auditor...
Job Category: Administrative Job Description: MAJOR FUNCTION: The Denial and Appeals Coordinator tracks... and coordinates third party payer activity and timeliness of organizational response. Identifies, analyzes, and reports denial trends...
Appeals and Denials Nurse Manager (Onsite - Miami Beach) As Mount Sinai grows, so does our legacy in high-quality... and retrospectively, as needed. Supports the clinical denial management process, ensuring that all denials related to medical necessity...
necessity and denial prevention; Coordination with payers to authorize appropriate level of care and length of stay... from payers as well as managing concurrent disputes. Collaborating with payers, physicians, office staff, and ancillary...
of the plan of care, and collaborates with the Denials team assisting to prevent concurrent and retrospective denials. The... denial mitigation. Department Specific Job Details: Education Completion of accredited RN program with current RN...
management scope of services including: Utilization Management supporting medical necessity and denial prevention; Transition... of implementation of the transition plan -leading and facilitating multi-disciplinary patient care conferences -managing concurrent...
Members. This will be accomplished through concurrent review processes using nationally recognized criteria. The Integrated... Transitional Care Nurse, RN will participate in providing transitional care services to the Members with each transition...
The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical, financial... and coordination to decrease avoidable delays denial of reimbursement. Specific functions within this role include: Screens pre...
Are you a registered nurse ready to take your career in an exciting new direction—one where your expertise truly makes... of a passionate, mission-driven team dedicated to improving healthcare across the Commonwealth. Are you a registered nurse ready...
Are you a registered nurse ready to take your career in an exciting new direction—one where your expertise truly makes... of a passionate, mission-driven team dedicated to improving healthcare across the Commonwealth. Are you a registered nurse ready...
for denial avoidance strategies including concurrent payer communications to resolve status disputes. Qualifications...RN Utilization Management Nurse – Frontline Opportunity Greater Orlando, Florida The RN Utilization Management Nurse...
, etc. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration issues such as Social Security... activities required to properly investigate claims such as Subrogation, Risk Control, nurse consultants, and fire or fraud...
on relatively complex case types that require the training and skill of a registered nurse. Acts as a resource for more junior... pre-certification, concurrent, retrospective, out of network and/or appropriateness of treatment setting reviews...
of benefits, communication of information to insurance company, billing certifications, concurrent managed care denial appeals... and Certifications Required: NJ State Professional Registered Nurse License. AHA Basic Health Care Life Support HCP Certification...
reviews. The employee communicates with physician and case managers regarding payor approval/denial of admission and continues... conducts admission and concurrent reviews including observation and inpatients, identifies patients who do not meet criteria...
, co-insurance, coverage limits, etc. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes... such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators and to other experts. Requests through Unit Manager...
% a. Completes all job requirements related to prospective, concurrent and retrospective case review and reporting quality issues... efficiency of services provided and minimize consumption of resources. e. Triages concurrent denials for potential P2P...
, etc. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration issues such as Social Security... activities required to properly investigate claims such as Subrogation, Risk Control, nurse consultants, and fire or fraud...