RN Utilization Review & Denial Specialist (Hybrid)
Surgery Partners
A healthcare organization in Texas is seeking an RN Utilization Review Coordinator to perform utilization reviews and ensure medical necessity compliance. The role involves collaborating with healthcare teams, managing denial appeals, and supporting discharge planning. Candidates should possess a Bachelor's in Nursing and an active Texas RN license along with at least five years of relevant experience. This full-time hybrid position emphasizes attention to detail and critical thinking skills. #J-18808-Ljbffr
- ...Hiring Now for RN Utilization Review Coordinator Department: Case Management Shift: Full-time Hybrid Job Summary The RN Case Manager/Utilization Review is responsible for performing... ...admission status determinations, active denial management, and collaboration with...SuggestedFull timeLocal areaShift work
- ...Department: Managed Services This position will be hybrid in the Dallas, Texas area. Relocation assistance... ...There are 6 open positions for this role. The Utilization Management (UM) RN performs utilization review activities, including, but not limited to,...SuggestedWork at officeRemote workRelocation package
- ...Utilization Review Coordinator This is a PRN position About Company: We're officially a Great Place To Work! We've always believed that... ...health or chemical dependency setting. Licensure: Current RN, LCSW, or LPC license preferred. Skills and Competencies:...SuggestedFull timePart timeReliefWeekend work
- ...A healthcare institution in Addison, TX seeks an experienced Registered Nurse (RN) to oversee the Case Management team focusing on Utilization Review. Responsibilities include managing departmental operations, ensuring compliance with regulations, and improving care coordination...SuggestedFull time
$23 per hour
...join our amazing team and work a hybrid schedule! The Loss Mitigation Specialist will be responsible for educating... ...documents. Communicate approval or denial of a loss mitigation workout... ...regarding account information. Reviews borrowers’ financial hardship documentation...SuggestedHourly payTemporary work- ...Accounts Receivable Ii Specialist Hours of Work: 40 Days Of Week... ...: Analyze and review outstanding claims, focusing on those with no response or denials. Identify and rectify errors,... ...address claim denials promptly. Utilize knowledge of payer policies,...Work at officeWork from homeMonday to FridayShift work
- ...(“IES”) is seeking a Coding Specialist with emphasis on surgical services... ...fee coding and documentation review for assigned surgical service... ...Work will be based in a Hybrid format at the corporate office... ...claim submission and reduce denials. Audit coding accuracy through...Work at officeLocal areaRemote workMonday to FridayNight shift
$54.38k
...USA Sr. Specialist, Pricing (Hybrid Role) Country: United States of America It Starts Here:... ...based on multiple data resource. Utilize data mining and data analysis to develop... ...Sets up frequent multi-organizational reviews of key metrics and develop root causes...Hourly payFull timeContract workWork experience placementShift work- ...OrthoMed Anesthesia in Addison, TX seeks a Healthcare Claims Denial Management Specialist to identify, analyze, and resolve denied or underpaid medical claims. Responsibilities include reviewing claims, communicating with insurance, and ensuring compliance with regulations...
- ...seeks a qualified medical certification professional to conduct reviews for medical necessity. The role demands extensive nursing... ...based guidelines. You'll support both acute care and resource utilization, offering a unique opportunity to grow within a renowned healthcare...Relief
- ...Description Conduct medical certification review for medical necessity for acute care... ...related to admission qualifications, resource utilization, national and local coverage... ...program and holds an active unrestricted RN license in the State of Texas Experience:...Full timeReliefWork at officeLocal areaNight shift
$21 per hour
Leave and Disability Specialist 6 month contract to hire Dallas, TX (Hybrid) Working with general supervision, the Leave... ...well as special duties as assigned. Utilize internal and external vendor... ...ongoing procedures to collect and review information needed to manage an organization...Contract workWork at office- ...experience and 2 years of ECMO specialist experience ~... ...(CCRN) CERT CRITICAL CARE RN (E-AEC) ELSO Adult ECMO Practitioner... ...needs and expectations and utilizes these in conjunction with the... ...family participation in care. Reviews personalized patient plan of...Hourly payFull timePart timeShift work
- ...becoming a Supervisor for the Denial Resource Center. You will... ...administrative staff. Assign tasks, review productivity levels. Keep... ...internal use and external partners. Utilize tools to track account status... ...Must be a registered nurse (RN). Hybrid expectation—on-site as needed...Work experience placementImmediate startRemote work
$55k - $65k
...an accommodation or an alternative application process. Denials & Appeals Specialist Full Time Dallas, TX, US 6 days ago Requisition ID: 1259... ...Mesquite. As part of the HHM team, you would be responsible for reviewing, analyzing, and resolving denied healthcare claims by...Full timeTemporary workLocal areaMonday to Friday- ...Eligibility Specialist About Patriot Growth Insurance Services: Founded in 2019, Patriot... ...Work Arrangement: This is a full-time hybrid position working in our office located in... ...systems, carriers, and vendor platforms. Review and reconcile carrier invoices, identify...Full timeTemporary workWork at officeLocal areaFlexible hours
- ...BDR Enablement Specialist – Hybrid 3x/Week DFW at Birdeye in Dallas, TX, United States Sales Full‑time About Birdeye Birdeye is the leading... ...agents that execute work at the location level — responding to reviews, updating listings, publishing content, and driving...Full timeWork at officeRemote workWork from homeMonday to FridayFlexible hours3 days per week
- ...Oms Medical Billing in Addison, TX is hiring an Appeals Specialist. This full-time position requires on-site presence during regular business hours at our corporate office. The ideal candidate will review denied claims, prepare and submit appeal letters, and communicate...Full timeWork at office
- ...experience and 2 years of ECMO specialist experience Licenses and... ...CCRN) Certified Critical Care RN (E-AEC) ELSO Adult ECMO Practitioner... ...needs and expectations, and utilize these in conjunction with the... ...family participation in care. Review personalized patient plan of care...Hourly payFull timePart timeShift work
- ...profitability. Also depending upon assigned role may be responsible for reviewing claim information to ensure accuracy and provide feedback to... ...clinical and non-clinical areas regarding claim errors and/or denials, and for providing cross coverage for areas not primarily...
$82k - $164k
...Principal Specialist, Fp&A The RTX Enterprise Services Strategic Affordability Analysis... ...and reasonable price recommendation to be utilized for supplier and customer negotiations... ...Apply Now! Work Location This is a hybrid role, eligible candidates must reside within...Temporary workWork experience placementRelocationFlexible hours- ...A healthcare organization is seeking a Denials & Appeals Specialist in Dallas, TX. The role involves reviewing and resolving denied healthcare claims and preparing appeals to insurance companies. Candidates should have 3-5 years of related experience and a strong understanding...
- ...Emergency Services, LLC is seeking a Coding Specialist to accurately code surgical services and... ...medical records, conducting claim reviews, and collaborating with providers for optimal... ...coding specificity. The position is hybrid, based in North Dallas, TX, with responsibilities...
- ...Dallas area. Must have CA RN license or be open to... ...Emergency Prospective Review (EPR) / Transfer Center... ...supervises the EPRN-LVN, in utilization review with a prominent... ...care (PSC) denial to facilities and providers... ...position is considered hybrid with remote and in-office...Work at officeRemote workRelocation packageShift work
$29.05 - $67.97 per hour
...Description Job Summary Utilizing clinical knowledge and... ...experience, responsible for review of documentation to... ...medical directors on denial decisions. - Supplies criteria... .... - Registered Nurse (RN). License must be... ...Certified Medical Audit Specialist (CMAS), Certified Case...Hourly payWork experience placementWork at office- Overview Accurate and timely coding and review of home health OASIS assessments and plan... ...improvement efforts, and manage visit utilization. Responsibilities Review and analyze OASIS... ...• Certification as a Home Health Coding Specialist (HCS-D) • Certification as OASIS...
$150k
...and wellness program. Position Overview The Pre Underwriting Specialist (Hybrid) is responsible for fully qualifying and pre‑underwriting... ...disclosure delivery and processing, emphasizing thorough upfront review, documentation accuracy, and thoughtful evaluation of...Temporary workSelf employmentLocal area- ...Innovations (BI) in Addison, TX, seeks an experienced AP Accounting Specialist to manage high-volume invoice processing. You will own full-... ...making a difference in the lives of children with autism, with hybrid work options and competitive benefits. #J-18808-Ljbffr...
$60k - $70k
...& Marketing is seeking a LOA Administrator in Dallas, TX. This full-time hybrid position involves managing LOA, Return to Work, and Accommodation requests. Key responsibilities include reviewing claims, ensuring compliance with regulations, and collaborating with various...Full time- ...Description - Coding Specialist III (250000US) UT Southwestern... ...accurate and timely review of complex coding and... ...of UTSW accounts utilizing ICD-10-CM, HCPCS, and... ...edits and back-end coding denials Maintains a thorough... ...multiple specialties in a hybrid role as needed....Full timeLive inRemote workWork from homeMonday to FridayFlexible hoursShift work
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