Current jobs related to Clinical Appeals Registered Nurse - Huntsville Texas - Huntsville Memorial Hospital
-
Clinical Appeals Nurse
4 weeks ago
Huntsville, Texas, United States Huntsville Memorial Hospital Full timeJob Title: Clinical Appeals NurseAt Huntsville Memorial Hospital, we are seeking a highly skilled Clinical Appeals Nurse to join our team. As a Clinical Appeals Nurse, you will play a critical role in reviewing and appealing denied medical services, ensuring that our patients receive the care they need.Key Responsibilities:Review medical records and...
-
Clinical Appeals Nurse
1 week ago
Huntsville, Texas, United States Huntsville Memorial Hospital Full timeJob SummaryWe are seeking a highly skilled Clinical Appeals Nurse to join our team at Huntsville Memorial Hospital. The successful candidate will be responsible for reviewing and appealing denied medical services, ensuring that patients receive the care they need.Key Responsibilities:Review medical records and determine potential for appeal on denied...
-
Clinical Nurse RN Clinic
2 weeks ago
Huntsville, Alabama, United States Huntsville Hospital Full timeJob Title: Clinical Nurse RN ClinicAt Huntsville Hospital, we are seeking a skilled Clinical Nurse RN Clinic to provide exceptional patient care in our office setting.Responsibilities:Provide professional nursing care to patients following established standards and procedures.Collaborate with healthcare teams to ensure seamless patient care.Develop and...
-
Clinical Nurse
2 weeks ago
Huntsville, Alabama, United States HH Health System Full timeJob Title: CLN RN ClinicAt HH Health System, we are seeking a skilled Clinical Nurse to join our team in a dynamic office setting.Job Summary:We are looking for a highly motivated and compassionate Clinical Nurse to provide exceptional patient care in our office clinic. As a key member of our healthcare team, you will be responsible for delivering...
-
Registered Nurse
1 month ago
Lubbock, Texas, Lubbock County, TX, United States Incredible Health Full timeHospitals on Incredible Health are actively hiring and accepting applications in the Lubbock, TX area for the following position: Registered Nurse - Clinical Nurse Educator. Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical Educator, Clinical Instructor, Diabetes educator, Nursing Professor, or Preceptor. ...
-
Surgical Registered Nurse
2 months ago
Huntsville, Texas, United States Huntsville Memorial Hospital Full timeAbout the RoleHuntsville Memorial Hospital is seeking a skilled and compassionate Registered Nurse to join our Surgical team on a per diem basis. As a key member of our healthcare team, you will provide high-quality patient care and contribute to the success of our hospital.Key ResponsibilitiesAssessment and Planning: Conduct thorough assessments of...
-
Registered Nurse
3 weeks ago
Texas, United States CHRISTUS Health Full timeOverview:The skilled Registered Nurse, operating within a similar healthcare environment, works autonomously while being cognizant of all pertinent elements of a clinical scenario. Provides both routine and intricate patient care, focusing on long-term objectives and strategies. Continues to enhance the capability to manage and navigate the complexities of...
-
Registered Nurse
2 months ago
Texas, United States CHRISTUS Health Full timeOverview:The skilled Registered Nurse operates autonomously within a similar healthcare environment, exhibiting a comprehensive understanding of all pertinent elements of patient care. This role encompasses both routine and intricate nursing responsibilities, focusing on long-term objectives and strategic planning. The nurse continually hones their ability...
-
Registered Nurse
1 month ago
Irving, Texas, Dallas, TX, United States Incredible Health Full timeHospitals on Incredible Health are actively hiring and accepting applications in the Irving, TX area for the following position: Registered Nurse - Emergency Clinical Educator. Nurses with experience in any of the following areas are strongly encouraged to apply: Care of psychiatric patients, Clinical Educator, Clinical Instructor, Diabetes educator, Fast...
-
Clinical Nurse RN
2 weeks ago
Huntsville, Alabama, United States Huntsville Hospital Health System Full timeJob Title: Clinical Nurse RNOverviewWe are seeking a skilled Clinical Nurse RN to join our team at Huntsville Hospital Health System. As a Clinical Nurse RN, you will provide professional nursing care for office patients following established standards and procedures.Responsibilities:Provide high-quality patient care in a fast-paced office settingCollaborate...
-
Registered Nurse
4 weeks ago
Huntsville, Alabama, United States Huntsville Hospital Full timeJob SummaryThe Registered Nurse identifies patient needs and priorities for care through assessment, planning, and delegation. The nurse evaluates patient response to care and attainment of expected outcomes, ensuring accountability for patient care delivered during the assigned shift.QualificationsEducation: Graduate of an accredited school of nursing with...
-
Surgical Registered Nurse
2 months ago
Huntsville, Texas, United States Huntsville Memorial Hospital Full timePOSITION SUMMARYUnder the general oversight of the Charge Nurse, the Staff Registered Nurse applies professional nursing expertise through the nursing process in delivering patient care. This role involves assessing, planning, implementing, and evaluating care for designated patients. Acts as an advocate for patients within the healthcare system. Responsible...
-
Travel Nurse Position
3 weeks ago
Huntsville, Alabama, United States Travel Nurse Source Full timeJob Title: Travel Registered NurseWe are seeking a qualified Stepdown RN to join our team at Travel Nurse Source. This is a great opportunity to work with a reputable staffing agency and gain valuable experience in a dynamic healthcare environment.About the PositionLocation: Birmingham, ALShift: HR Nights, 19:00:00-07:00:00Duration of Assignment: 91 DaysPay...
-
Clinical Nurse
2 weeks ago
Huntsville, Alabama, United States Huntsville Hospital Health System Full timeJob Title: Clinical Nurse - Office SettingAt Huntsville Hospital Health System, we are seeking a highly skilled and dedicated Clinical Nurse to join our team in an office setting. As a Clinical Nurse, you will be responsible for providing professional nursing care to office patients, following established standards and procedures.Responsibilities:Provide...
-
Registered Nurse
3 months ago
Jacksonville, Texas, Cherokee County, TX, United States UT Health Jacksonville Full timeOverviewJoin our team as a day shift, full-time, Emergency Room Registered Nurse Clinical Coordinator in Jacksonville, TX. Fulfilling your purpose begins here: People First, Always. Here’s how we take care of our people:Medical, vision, dental health insurance, health savings account / flexible spending, competitive pay, paid time off, 401k retirement...
-
Clinical Nurse
4 days ago
Huntsville, Alabama, United States Huntsville Hospital Health System Full timeJob SummaryAs a Clinical Nurse at Huntsville Hospital Health System, you will provide professional nursing care for office patients following established standards and procedures. This role requires a graduate of an accredited school of nursing with a current Alabama State Registered Nurses License and current CPR certification. ACLS certification is...
-
CLN RN Clinic
2 weeks ago
Huntsville, United States HH Health System Full timeProvides professional nursing care for office patients following established standards and procedures. Minimum Knowledge, Skills, Experience Required:Education:Graduate of an accredited school of nursing. Possess a current Alabama State Registered Nu Clinic, RN, Hospital, Healthcare, Program, Benefits
-
Clinical Nurse
4 days ago
Huntsville, Alabama, United States Huntsville Hospital Health System Full timeJob SummaryWe are seeking a skilled Clinical Nurse to join our team in a dynamic office setting. As a key member of our healthcare team, you will provide high-quality patient care, working collaboratively with physicians and other healthcare professionals to ensure the best possible outcomes.Key ResponsibilitiesProvide professional nursing care to office...
-
Clinical Health Specialist
3 days ago
Huntsville, Alabama, United States DOCS Health Full timeJob Title: Clinical Health SpecialistJob Summary: We are seeking a skilled Clinical Health Specialist to provide health readiness services to military personnel under the Reserve Health Readiness Program (RHRP) in the State of Texas.Responsibilities:Support Physical Health Assessments of military personnel.Review health history, service member medical...
-
Travel Nurse Position
3 weeks ago
Huntsville, Alabama, United States Travel Nurse Source Full timeJob Title: Registered Nurse - OB - Labor & DeliveryTravel Nurse Source is working with TRS Healthcare to find a qualified Labor/Delivery RN in Birmingham, Alabama.About the PositionThe Registered Nurse assumes responsibility and accountability for incorporating the vision, values, mission and critical goals of the organization into their job...
Clinical Appeals Registered Nurse
2 months ago
Position Overview:
Under the guidance of the Director of Case Management, the Clinical Appeals Registered Nurse is responsible for reviewing and contesting medical service denials that may have occurred during the initial claims assessment phase.
Denials may arise from inadequate medical documentation, billing discrepancies, utilization assessments, or determinations regarding the medical necessity of the provided treatment.
Key Responsibilities:
While this job description aims to be comprehensive, it does not encompass all duties the incumbent may be expected to perform. The absence of specific tasks does not exclude them from the role if they are similar or related.
1. Assess records to identify potential appeals for denied claims.
2. Compose appeal letters utilizing clinical expertise and knowledge, ensuring they are written in an objective narrative format, adhering to proper structure, grammar, and current accepted medical criteria and literature.
3. Analyze denials based on the type, frequency, extent, location, and duration of the patient's condition or injury.
4. Collect necessary documentation, including prior determination details and complete medical records for evaluation.
5. Write professionally, ensuring a thorough review of clinical facts, and include valid reasons for reconsideration of the denial.
6. Submit appeals along with medical records to the relevant parties promptly.
7. Maintain logs for follow-up purposes, including reports requested by payors.
8. Foster personal professional development by fulfilling mandatory and continuing education requirements, and support departmental goals that contribute to the organization's success.
9. Act as a mentor and resource for less experienced staff members.
10. Exhibit adaptability, problem-solving skills, and professionalism consistently.
11. Adhere to the organization's Legal Compliance Code of Conduct.
12. Ensure patient confidentiality and proper handling of Protected Health Information (PHI).
13. Maintain a safe working environment and report safety issues appropriately.
14. Perform additional related duties as assigned.
Collaboration and Interaction:
All roles at Huntsville Memorial Hospital are part of an interdisciplinary team, contributing to the care and service delivery process through effective collaboration with other team members. The Clinical Appeals Registered Nurse primarily interacts with hospital personnel, medical staff, patients, and visitors.
Qualifications:
Education: Graduate of an accredited nursing program.
Experience: A minimum of two years of experience in managing and facilitating the appeals process for acute care hospital denials is preferred. Familiarity with MCG and InterQual guidelines is advantageous.
Licensure/Certification: Must hold a current Registered Nurse license in the state of Texas or be immediately eligible.
Required Skills: Strong analytical, data management, organizational, and time management skills are essential.
Physical Demands and Working Conditions:
Frequent: Sitting, standing, walking, and reaching.
Occasional: Lifting, carrying, bending, and squatting.
Visual and auditory acuity is required. The work environment is primarily indoors, with good ventilation and a comfortable temperature, as well as occasional outdoor activities that may require driving.
Potential Exposure: Toxic or caustic chemicals, communicable diseases, and bloodborne pathogens.
Benefits:
- Health Care Plan (Medical, Dental & Vision)
- Retirement Plan (401k, IRA)
- Life Insurance (Basic, Voluntary & AD&D)
- Paid Time Off
- Short Term & Long Term Disability
- Training & Development
- Wellness Resources
