Hybrid Utilization Review RN
6 days ago
Hybrid position, in Annapolis, MD. Onsite 2 days a week, remote 3 days a week.
Qualifications:
- At least three years of experience required in one of the following areas: clinical, case management, denials, billing
- Previous experience as an acute RN preferred
- Registered nurse (RN) licensure required, bachelor’s degree in nursing preferred
- Certification in at least one of the following preferred: certified healthcare chart auditor, certified professional in utilization review (or utilization management or healthcare management), certified case manager, certified documentation specialist, certified coder, certified professional medical auditor, or similar program
Position Summary
The clinical denial appeals specialist is responsible for the identification, mitigation, and prevention of clinical denials. This staff member reviews all initial clinical denials to determine next steps and conducts appeals as appropriate, such as by reviewing medical necessity, responding to authorization concerns, and/or reconciling coverage-related issues. The clinical denial appeals specialist also works to prevent future clinical denials by communicating with clinical and revenue cycle leadership about denial root causes, such as documentation gaps or insufficient charge capture, and helps develop and implement staff education and process changes.
Pay: $83,200.00 - $124,800.00 per year (Based on experience, education, certifications, etc). Benefits offered by employer
-
Clinical Denials
16 hours ago
Annapolis, United States Insight Global Healthcare Full timeJob DescriptionJob DescriptionMust-haveRN license, BSN strongly preferredAt least 3 years of experience doing clinical denialsExperience within utilization review or management (specifically handling appeals and denials)PlussesPrevious experience as an acute RNCertification in at least one of the following:Certified healthcare chart auditorCertified...
-
HYBRID Clinical Denials
17 hours ago
Annapolis, United States Insight Global Full timeJob DescriptionJob Description Must-haveRN license, BSN strongly preferredAt least 3 years of experience doing clinical denialsExperience within utilization review or management (specifically handling appeals and denials)PlussesPrevious experience as an acute RNCertification in at least one of the following:Certified healthcare chart auditorCertified...
-
Hybrid Coding Analyst
6 days ago
Annapolis, United States Insight Global Healthcare Full timeJob DescriptionJob DescriptionHybrid position, out of Annapolis, MD.Qualifications:Associate degree in business, healthcare, or related field is required.Current coding certification (RHIA, RHIT, CPC, CCS) is required.Three years of medical coding, denial management, and/or reimbursement experience is required Job Description: The coding denial analyst...
-
Hybrid Mental Health Clinician
3 weeks ago
Annapolis, United States Insight Global Healthcare Full timeJob DescriptionJob DescriptionMust Haves:Licensed Certified Social Worker (LCSW) or Licensed Certified Social Worker Clinical (LCSW-C ) from the Maryland Board of Social Work Examiners or Licensed Clinical Professional Counselor (LCPC ) from the Maryland Board of Professional CounselorsMaster's Degree in related clinical fieldDay to Day:Insight Global...
-
Mental Health Clinician
6 days ago
Annapolis, United States Insight Global Healthcare Full timeJob DescriptionJob DescriptionMust Haves:Licensed Certified Social Worker (LCSW) or Licensed Certified Social Worker Clinical (LCSW-C ) from the Maryland Board of Social Work Examiners or Licensed Clinical Professional Counselor (LCPC ) from the Maryland Board of Professional Counselors from the Maryland Board of Counselors.Master's Degree in related...
-
Hybrid Coding Denials
2 weeks ago
Annapolis, United States Insight Global Full timeHybrid position, out of Annapolis, MD.Qualifications:Associate degree in business, healthcare, or related field is required.Current coding certification (RHIA, RHIT, CPC, CCS) is required.Three years of medical coding, denial management, and/or reimbursement experience is requiredJob Description: The coding denial analyst supports the denial management team...
-
Hybrid Coding Denials
2 weeks ago
Annapolis, United States Insight Global Full timeHybrid position, out of Annapolis, MD.Qualifications:Associate degree in business, healthcare, or related field is required.Current coding certification (RHIA, RHIT, CPC, CCS) is required.Three years of medical coding, denial management, and/or reimbursement experience is requiredJob Description: The coding denial analyst supports the denial management team...
-
Coding Denials and Appeals Analyst
2 weeks ago
Annapolis, United States Insight Global Healthcare Full timeJob DescriptionJob DescriptionInsight Global is seeking a Coding Denials and Appeals Analyst to support a large healthcare system based out of Annapolis, MD. The Coding Denials and Appeals Analyst supports the denial management team by reviewing claims denied for coding-related root causes, as well as suggesting process improvements to reduce future...
-
Medical Review Specialist
1 week ago
Annapolis Junction, United States Livanta Full timeSummaryLivanta is the largest healthcare quality improvement organization in the United States and trusted adviser to the Centers for Medicare and Medicaid Services (CMS). We have a unique understanding of beneficiaries and have developed programs that improve beneficiary outcomes, increase satisfaction, and drastically reduce readmission. With technology at...
-
Senior Accountant
3 months ago
Annapolis, United States Jobot Full timeJob DescriptionJob DescriptionClient Accounting Advisory Senior (Hybrid) / $$$ / Regional CPA firmThis Jobot Job is hosted by: Joseph SipoczAre you a fit? Easy Apply now by clicking the "Apply Now" buttonand sending us your resume.Salary: $65,000 - $95,000 per yearA bit about us:We are a local/regional CPA firm that has been in business for nearly 50 years,...
-
Insight Global | Hybrid Coding Denials
2 weeks ago
annapolis, United States Insight Global Full timeHybrid position, out of Annapolis, MD.Qualifications:Associate degree in business, healthcare, or related field is required.Current coding certification (RHIA, RHIT, CPC, CCS) is required.Three years of medical coding, denial management, and/or reimbursement experience is requiredJob Description: The coding denial analyst supports the denial management team...
-
Hybrid Business Intelligence/Report Developers
5 months ago
Annapolis, United States HonorVet Technologies Full timea. B.S. degree in Computer Science or related field (as determined by the Client) b. Five (5) or more years' experience in MS SQL Server (writing and performance tuning) The proposed resource(s) shall provide development services of processes and procedures associated with receipt, review, approval, and fulfillment of report and query requests utilizing the...
-
Land Origination Professional
5 days ago
Annapolis, Maryland, United States New Energy Equity Full timeAbout the RoleWe are seeking a skilled Associate, Land Origination to support our Land Managers in identifying, assessing, and securing suitable locations for community solar projects. This is a hybrid role based out of our Roseville, MN, Annapolis, MD or Horseheads, NY offices.Key Responsibilities:Conduct thorough research to identify potential community...
-
Annapolis Junction, United States Zachary Piper Full timeZachary Piper Solutions is seeking a Sr Java Developer to join a government consulting firm for a hybrid opportunity. This Java Developer will work on cutting-edge projects, leveraging skills in both front-end and back-end development.Responsibilities:Develop and maintain web applications using Java, Spring Boot, and related technologies.- Design and...
-
Hybrid Software Engineer 3
7 days ago
Annapolis Junction, United States Waypoint Human Capital Full timePosition Title: Software Engineer 3 - AI/ML Position Type: Hybrid Location: Annapolis Junction, MD Clearance Required: TS/SCI w/ Poly (required) Waypoint's customer is seeking a Java & Python Software Engineer 3 with Machine Learning (ML) & Artificial Intelligence (AI) experience. The ideal candidate will be responsible for designing and developing...
-
Case Manager
2 months ago
Annapolis, United States Luminis Health Full timeCase Manager (RN) Anne Arundel Medical Center, Annapolis, MD Full Time - Day Shift (M-F, 8a-4:30pm and rotate every 3rd or 4th weekend) Position Objective: The Case Manager works under the direction of the clinical director of care management, providing coordination of care for patients at Anne Arundel Medical Center to support safe, seamless,...
-
Nurse Case Manager
2 months ago
Annapolis, United States Incredible Health Full timeHospitals on Incredible Health are actively hiring and accepting applications in the Annapolis, MD area for the following position: Nurse Case Manager (RN). Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift Job types available: full...
-
Case Manager
2 months ago
Annapolis, United States Luminis Health Full timeCase Manager (RN) Anne Arundel Medical Center, Annapolis, MD Full Time - Day Shift (M-F, 8a-4:30pm and rotate every 3rd or 4th weekend) Position Objective: The Case Manager works under the direction of the clinical director of care management, providing coordination of care for patients at Anne Arundel Medical Center to support safe, seamless, timely...
-
Case Manager
1 month ago
Annapolis, United States Luminis Health Full timeCase Manager (RN) Anne Arundel Medical Center, Annapolis, MD Full Time - Day Shift (M-F, 8a-4:30pm and rotate every 3rd or 4th weekend) Position Objective: The Case Manager works under the direction of the clinical director of care management, providing coordination of care for patients at Anne Arundel Medical Center to support safe, seamless, timely...
-
Senior RF Systems Specialist
7 days ago
Annapolis, Maryland, United States Crossfire Consulting Full timeOverviewCrossfire Consulting seeks a skilled Senior RF Systems Specialist to join our team in Annapolis Junction. This hybrid role combines in-office and remote work, offering an excellent opportunity for technical expertise and strong project management skills.Salary: $120,000 - $150,000 per yearJob DescriptionWe are looking for an experienced RF Engineer...