RN Clinical Review Specialist I - Care & Appeals
IntelliResume
Upstate Medical University in Syracuse, NY is seeking a Commercial Review Specialist I to ensure patient care services are recorded and utilized according to hospital standards, regulatory policies, and reimbursement contracts. The role emphasizes strong clinical knowledge and effective communication within care teams. Responsibilities include chart reviews, first-level screening, collaboration with medical teams and UR medical directors to determine levels of care, and handling discharge #J-18808-Ljbffr IntelliResume
Vacancy posted 5 days ago
Similar jobs that could be interesting for youBased on the RN Clinical Review Specialist I - Care & Appeals in Syracuse, NY vacancy
- ...insurance, and also deals in Medicare managed care plans, and Medicare prescription drug... ...Day to Day Responsibilities: The Clinical Appeals RN performs the clinical appeals in accordance... ...Medical Director or external Physician Reviewer for their reconsideration (appeal)...SuggestedContract workImmediate start
- ...University in Syracuse, NY seeks a UR-CR Specialist I to ensure accurate recording and utilization of patient care services. Through chart review and screening criteria, you will verify... ...will act as a liaison for discharge appeals and social admissions, preparing regulatory...Suggested
- ...healthcare staffing agency is seeking a Clinical Appeals RN in Syracuse, NY. This role involves performing... ...and preparing clinical documentation for review. The ideal candidate must be familiar with Medicaid contract and Managed Care Legislation. Strong analytical skills and...SuggestedContract workImmediate start
- Job TitleWith level of care screening criteria such as MCG or Interqual, CMS regulations as related to hospital admissions, utilization management or utilization review, and interfacing with health care payers/regulatory agencies.Suggested
AMN Healthcare
Syracuse, NY2 days ago - ...RN Utilization Review Coordinator The RN Case Manager/Utilization Review is... ...progression through the episode of care. This position also assists... ...in a bed) based on clinical documentation, hospital-approved... ..., write, and submit denial appeal letters using clinical judgment...SuggestedFull timeLocal area
- ...The Clinical Educator identifies and provides ongoing training, coaching... ...regulatory requirements. Review and evaluate training and... ...nurse management role in a health care setting required. Acute psychiatric... ...Licenses - Valid Texas RN license in good standing required...Full timeApprenticeship
Dallas Behavioral Healthcare Hospital
Desoto, TX5 days ago $65 per hour
...RN Case Manager / Utilization Review - Syracuse, NYLocation: Acute Care/Academic Medical Center, Syracuse, NYEmployment Type: Full-timeHourly Rate: $65/hourGreenlife... ...tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private...Private practiceMonday to FridayDay shiftGreenLife Healthcare Staffing
Syracuse, NY2 days ago$65 per hour
...RN Case Manager / Utilization Review - Syracuse, NY (#25268) Location: Acute Care/Academic Medical Center, Syracuse, NY Employment Type: Full-time Hourly Rate... ...opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups,...Hourly payFull timePrivate practiceMonday to FridayDay shiftGreenLife Healthcare Staffing
Syracuse, NY3 days ago$28 - $32 per hour
...Savings Plan Maxcares Awards Program Responsibilities: Utilize the nursing process to assess, plan, implement, and evaluate patient care. On each assignment, provides skilled nursing care/services in accordance with prescribed orders Assess signs and symptoms indicating...Hourly payWeekly payTemporary workAvir at The Renaissance
Dallas, TX3 days ago- ...Clinical Specialist For Wound Care SuppliesAsure Wound Solutions is seeking a highly skilled and dedicated Clinical Specialist for Wound Care Supplies to join our team. This is a remote position based in the Dallas area and requires experience working in nursing homes...Work at officeRemote workMonday to FridayShift work
IntelyCare
Dallas, TX15 hours ago - Job Description Job Title: RN Case Manager/Utilization Review/CDI Job Location: Syracuse, NY 13210 Shift: Days (7AM-3:30PM). EOW. 40 hours/week. Duration... ...recent experience (within past 2 years) in an acute care facility of similar size and level as Hospital. Must have...Contract workLocal areaShift work
- ...Utilization Review RN Are you seeking an impactful nursing role? As a Utilization Review... ...Your expertise shines through meticulous clinical reviews using established criteria. You play... ...by optimizing resources and implementing care plans. Communication with health plan...ReliefLocal area
- ...You supervise utilization review for RNs. You oversee processes... ...advising team on peer-to-peer appeals. Also conducting denial research... ...with the Medical Director and Care Coordination when patients don't meet criteria. Updating Clinical Resource Manager as needed....Work at office
- ...Addison, TX seeks an experienced Registered Nurse (RN) to oversee the Case Management team focusing on Utilization Review. Responsibilities include managing departmental... ...compliance with regulations, and improving care coordination. Candidates must have an RN license...Full time
$100k - $120k
...Full time R-089601 Job Title Clinical Informatics Specialist Agency Texas A&M University Health... ..., research, specialized patient care and continuing dental education. As one... ...letter and resume will assist us in our review of your application materials. These...Full timeContract workMonday to FridayFlexible hoursAfternoon shiftTexas A&M
Dallas, TX1 day ago- ...Clinical EducatorThe Clinical Educator identifies and provides ongoing training, coaching, and education for all employees. The role is... ...knowledge of state and Joint Commission regulatory requirements.Review and evaluate training and apprenticeship programs for...Apprenticeship
Dallas Behavioral Healthcare Hospital
Desoto, TX2 days ago - Upstate Medical University seeks a Clinical Nursing Education Training Specialist to teach and support clinical orientation programs, ongoing specialty education... ...participant records to ensure high-quality patient care and compliance with regulatory standards. Strong...
$36 - $38 per hour
...you have a desire to expand your talents in clinical education, we invite you to apply! You... ...application takes 5-7 minutes to complete. Our RN Clinical Educators experience a unique... ...expertise in a new way outside patient care, while continuing to collaborate with healthcare...Hourly payDaily paidExtra incomeFull timePart timeImmediate startWorldwideFlexible hoursIQVIA
Dallas, TX19 days ago- ...Clinical Data Specialist NYC, BOS or Dallas Iterative Health is a healthcare technology and services... ...directly in the communities where care is delivered across gastrointestinal,... ...responsible for conducting detailed EHR reviews to identify potential clinical trial...Temporary workWork at office2 days per week
Iterative Health
Dallas, TX2 days ago - Job Summary The Clinical Nursing Education Training Specialist teaches and supports clinical orientation programs, ongoing specialty, and general education... ...satisfactory clinical experience providing direct patient care required. Formal or informal teaching experience in...Monday to FridayFlexible hours
- Clinical Nursing Education Training Specialist The Clinical Nursing Education Training Specialist teaches and supports clinical orientation programs, ongoing... ...clinical experience providing direct patient care required. Outstanding oral and written communication skills...Full timeWork at officeFlexible hours
- ...PRN career opportunities as a Clinical Rehab Specialist PRN you want with your... ...other members of the patient’s care team to identify those patients... ...Specialist will review these patients daily until they... ...Occupational Therapy (OT), or (RN) Registered Nurse 2 years of...Temporary workReliefWork at officeFlexible hours
- ...moving each year while delivering clinical and economic value to... ...designed to advance patient care while delivering clinical and... ...the Regional Clinical Sales Specialist position include advancing the... ...What You Can ExpectApplication review: We’ll carefully review your...Full timeLocal areaWorldwideRelocationNight shiftWeekend work
- ...Description Summary: The RN Navigator Home Health Review plays a crucial role in monitoring post-acute... .... As a key member of the patient’s care team, the RN Navigator acts as a patient... ...and coordination of care with clinic providers. Responsibilities:...Full timeWork at officeMonday to Friday
Christus Health
Irving, TX9 days ago - A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing...Full timeRemote work
Innovative Systems Group
Richardson, TX1 day ago - ...invests in you as a(an) RN - Super Pool Women... ...counseling, long-term care coverage, moving assistance... ...00+ in-house physician specialists. Medical City Dallas has... ...emergency rooms, outpatient clinics and diagnostic centers.... ...Acquisition team is reviewing applications for our RN...Full timeTemporary workPart timeFlexible hours
Medical City Healthcare
Mesquite, TX2 days ago - ...Registered Nurse (RN)Helio Health is on a mission to treat and... ...follows medical orders for patient care.Communicate with supervisor,... ...medical care.Communicate with clinical staff regarding patients'... ...services.Develop, recommend, and review medical policies and procedures...Hourly payFull timeLocal areaShift work
Helio Health
Syracuse, NY2 days ago - ...seeking a skilled Cardiac Cath Lab RN for a 16-week travel... ...and the support of a dedicated clinical team.Required Qualifications:One... ...Cath Lab RN provides specialized care for patients undergoing... ...prior to procedures, including reviewing medical history and performing...Temporary workImmediate start
Fusion Medical Staffing
Syracuse, NY2 days ago - ...endoscopic surgery centers in Mesquite offering outstanding patient care in a comfortable environment. The physicians for Texas GI are... ...to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor....Full timeFor contractorsImmediate startMonday to Friday
AmSurg
Mesquite, TX2 days ago - ...patient-specific duties in the area of fertility including patient care, teaching, triage, procedures, and PACU recovery, in an... ..., questions, and concerns to the appropriate area.Communicates, reviews, records all laboratory results.Maintains factual and thorough health...
CNY Fertility
Syracuse, NY2 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to RN Clinical Review Specialist I - Care & Appeals. Be the first to apply!
Related searches
- unique rn Syracuse, NY
- med surg medical surgical rn registered nurse Syracuse, NY
- travel registered nurse rn Syracuse, NY
- rn outpatient surgery Syracuse, NY
- cath-lab rn Syracuse, NY
- behavioral rn Syracuse, NY
- injection rn Syracuse, NY
- pediatric icu rn Syracuse, NY
- private practice rn Syracuse, NY
- private rn Syracuse, NY