Denial Letters Nurse

Job DescriptionPosition Summary:The Denial Nurse is responsible for being the "second line" resource for preparing and maintaining health plan criteria for the campus Medical Directors. This includes collaborating with each Health Plan to obtain updated/adequate criteria for each specialty to ensure that appropriate criteria are referenced upon furnishing a...

DescriptionSummary: Responsible for the management and communication of denials/appeals received from third party payers, managed care companies, and/or government entities/auditors related to medical necessity and/or level of care. This associate will be a liaison and point of contact for clinical denials and appeal inquiries. The Clinical Appeals Nurse...

Job DescriptionMedPOINT ManagementTitle: Inpatient Nurse - Delegated Plans =====================================================================================MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your...

Job Title: Prior Authorizations Registered Nurse (RN)Summary:The UM Prior Authorization Nurse is responsible for evaluating referrals for medical services to determine medical necessity and appropriate course of action. Utilizing independent judgment, extensive medical knowledge, and adherence to clinical guidelines, the Prior Authorization Nurse...

Utilization Management Clinical Registered Nurse - The Health Plan - RemoteJob Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role...

Assists in the physician advisor process for cases sent for peer-to-peer review. Supports the scheduling of reviews, communicating the results and completing the required verbal and written correspondence.Provides non-clinical support to workflows involving utilization management.Performs outreach contact to providers and written notification to providers...

Utilization Management Clinical Registered Nurse (RN)Job Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role performs telephonic...

Utilization Management Clinical Registered Nurse (RN) - The Health PlanJob Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role...

SummaryJob DescriptionProvides leadership, support, training, and direction to the Inpatient UM teammates. The incumbent will use clinical judgment to provide utilization management review for inpatient during high volume situations. Provide high quality, cost-effective care to enable patients to achieve maximum medical improvement, while receiving care...

Utilization Management Coordinator (RN)Under the general supervision of the Director of Health Services, the position is responsible for appropriately and successfully executing clinical and administrative health plan denials in accordance with regulatory guidelines and plan policies. ESSENTIAL DUTIES AND RESPONSIBILITIES 1. Is responsible for managing all...

Your Role The Delegation Oversight Utilization Management  team is responsible for the organization, tracking and data entry of IPA Utilization Management audits, issues, complaints and monitoring. Identifies root cause of the problem and maintains monthly reporting that track and compare patters of delegated entities. The Delegation Operations Nurse...

UTILIZATION REVIEW NURSE (RN)Randallstown, MDNORTHWEST HOSPITALNW CARE MANAGEMENTFull-time - Day shift - 8:00am-4:30pmRN Other81988Posted:March 21, 2024Apply NowSave JobSavedSummaryPosition Summary:Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to...

Registered Nurse - Utilization Management - Full Time* Graduate of an accredited school of nursing required. * Current licensure as a Registered Nurse in the State of New Jersey POSITION SUMMARY The RN Utilization Management Days is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical...

NURSE RESIDENCY PROGRAM AT MLKCHThe MLKCH New Graduate RN Residency will prepare new nurses by organizing and overseeing all aspects of their transition into professional nursing. It is designed to be a highly-supportive, paced learning experience.As an RN Resident, you will be hired into the facility as a full-time employee. You will be...

Requirements / Qualifications APPLICATION PROCEDURE (Must apply online at www.edjoin.org) A complete application must include: 1. Completed application and materials submitted online 2. Letter of Introduction 3. Current Resume 4. Three (3) letters of recommendation 5. Applicants must meet qualifications and provide all necessary materials to qualify as a...

NURSE RESIDENCY PROGRAM AT MLKCHThe MLKCH New Graduate RN Residency will prepare new nurses by organizing and overseeing all aspects of their transition into professional nursing. It is designed to be a highly-supportive, paced learning experience.As an RN Resident, you will be hired into the facility as a full-time employee. You will be...

NURSE RESIDENCY PROGRAM AT MLKCHThe MLKCH New Graduate RN Residency will prepare new nurses by organizing and overseeing all aspects of their transition into professional nursing. It is designed to be a highly-supportive, paced learning experience.As an RN Resident, you will be hired into the facility as a full-time employee. You will be...

Registered Nurse* Initial clinical assessments, continued stays assessments, and payer requested reviews are performed using evidence based criteria as designed, medical experience based problem solving skills, and following the established policies and regulations governing this process in order to either obtain authorization or establish medical necessity...

Summary: Reviews applications and resumes and forwards to departments if applicants meet minimum requirements for the position. Interviews applicants and recommends to departments. Processes new hires by providing the offer letters. Essential Duties and Responsibilities include: Recruiter Responsibilities: Reviews packets with new hires, sets Gaming...

About the Employer We are pleased that you have expressed an interest in employment with our district. Desert Sands Unified School District is committed to the students and the families of the communities that we serve. We have a competitive salary and benefit package to offer our employees along with excellent working conditions in modern school...