RN Utilization Review: Denials & Appeals Specialist
$86.96k - $113.67kCapital Health Services
Capital-Health in Trenton, NJ is hiring a Utilization Review Nurse to manage inpatient case reviews and support appeals processes. The role requires extensive experience in nursing and case management, focusing on compliance with guidelines and regulations. Ideal candidates must be proficient in nursing fundamentals and utilization review software. This full-time position offers comprehensive benefits, including health and retirement plans, alongside a competitive salary range of $86,964.80 - $113,672.00. #J-18808-Ljbffr
- ...health care provider in Pennington, New Jersey, is seeking a qualified Registered Nurse for a full-time position focused on utilization review and quality management. Responsibilities include conducting patient assessments, collaborating with care teams, and ensuring...SuggestedFull time
$39.4 - $51.47 per hour
...Scheduled Weekly Hours 20 Position Overview Performs a variety of utilization and resource management activities to promote quality,... ...clinical nursing and three years quality management, utilization review or discharge planning experience. Other Credentials: Registered...SuggestedFull timeTemporary workPart timeWork at officeLocal areaImmediate startFlexible hoursNight shift- ...position status (e.g., part-time). Responsibilities Performs chart review of identified patients to identify quality, timeliness and... .... Gathers clinical information to conduct continued stay utilization review activities with payers daily. Performs concurrent and retrospective...SuggestedFull timeTemporary workPart timeWork at officeLocal areaFlexible hoursNight shift
$92.29k - $120.58k
...Health (US) in Lawrenceville, NJ, is seeking a Clinical Appeals Nurse to oversee clinical review, development, and submission of inpatient and... ...years of clinical nursing experience, particularly in utilization review. Strong communication skills and the ability to...Suggested$39.4 - $51.47 per hour
...Capital Health (US) in Trenton, NJ seeks a professional for a full-time position focused on utilization management. Responsibilities include assessing patient care quality and managing treatment plans effectively to optimize resources. The ideal candidate will have an...SuggestedHourly payFull timeFlexible hours- ...Job Title: Registered Nurse Department: Utilization Review Employment Type: Per Diem Shift: 8-hour... ...level of care. Management of all review and appeals utilizing a modified approach based on... ...s degree in nursing required. Active PA RN License required. Previous experience in...Daily paidPart timeLocal areaFlexible hoursShift workWeekend workDay shiftWeekday work
- ...all minds provide value and can contribute meaningfully. Note: New Jersey RN Active License is required. Role Description This is a Field work contract role for a Utilization Review Nurse. The Utilization Review Nurse will be responsible for performing utilization...Contract workRemote work
- A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing... ...coordinating discharge planning. Candidates must have an active RN license in New Jersey, strong analytical skills, and the...Contract workRemote work
- ...Job Title: Appeal Analyst RN I Job Location: Hopewell, NJ Job Duration: 6 Months (possibility... ..., bill verification, DRG validation (utilization review audits), and credit balances.... ...license required. Certified Coding Specialist (CCS) certification required....Daily paidContract work
$34.9 - $45.83 per hour
...procedures to patient. Obtains and records patient history. Reviews laboratory and other test results daily and prioritizes them for... ...state office location required. Must attain second out of state RN license (NJ or PA) within three months from date of hire. Experience...Full timeTemporary workPart timeWork at officeFlexible hours- ...Description POSITION TITLE : Peer Recovery Specialist with Youth REPORTS TO: Peer... ...service goals/plans, to promote supervisory review and feedback. Documents all work and... ...ethics and practices. Understands and utilizes established policies and procedures in...Work at officeLocal areaFlexible hours
$47.68 - $63.56 per hour
Capital Health (US) seeks a dedicated nurse to enhance patient care in Trenton, New Jersey. The role involves providing critical support during patient transport and managing complex clinical situations. Candidates should have at least one year of experience in critical...Hourly pay$119.85k - $171.39k
...findings. Orders tests and consults as required by plan of care and reviews test results. Reviews patient plan of care with... ...patient populations incorporating an interdisciplinary approach and utilizing best practices and research findings. Develops and revises patient...Full timeTemporary workPart timeFlexible hoursShift work$15 - $18.32 per hour
...seasons when required. Basic computer proficiency. Comfortable utilizing phones, fax machine, printers, and other general office... .... Any requests to be exempted from these requirements will be reviewed by Datavant Human Resources and determined on a case-by-case basis...Hourly payFull timeWork experience placementWork at office- ...and for our employees. Order Intake Specialist Under the direction and support of... ...initiate and process all sales orders after reviewing documentation, physicians' orders, and... ..., and Managed Care Insurances utilizing Brightree, websites available, and direct...
$15 per hour
...seasons when required. Basic computer proficiency. Comfortable utilizing phones, fax machine, printers, and other general office... .... Any requests to be exempted from these requirements will be reviewed by Datavant Human Resources and determined on a case‑by‑case basis...Hourly payFull timeWork experience placementWork at office$76k - $199.6k
...maintain customer engagement by successfully utilizing existing and ever-changing digital tools... ...Healthcare/Scientific roles (e.g., RN, Pharmacist, PT, OT, etc.) Educator (e.... ...public disclosure. Subject to further legal review and statutory or regulatory clarification...Permanent employmentFull timeH1bLocal areaRemote workVisa sponsorshipWork visaRelocation package$20 - $22 per hour
...claims for custom orthotics, prosthetics, and durable medical equipment (DME), utilizing specific HCPCS codes/modifiers. Investigate denied claims, analyze denial trends and prepare appeals backed by clinical documentation Ensure compliance with Medicare's Local...Local area$55k
...wellness and recovery. The Dual Disorder Specialist is responsible for the development,... ...substance abuse/dual disorder services utilizing the resources of the PACT team and those... ...screening, treatment planning and discharge review process assuring appropriate substance abuse...Full timePart timeMonday to FridayWeekend workAfternoon shift$70k
...procedures to patient. Obtains and records patient history. Reviews laboratory and other test results daily and prioritizes them for... ...state office location required. Must attain second out of state RN license (NJ or PA) within three months from date of hire. Experience...Daily paidFull timePart timeWork at office- ...Job Description Job Description Job Title: Peer Recovery Specialist (PRS) Reports To: Recovery Center Employee Type: Part... ..., PowerPoint, Outlook and possess basic computer skills. Must utilize the Recovery Data Platform (RDP), Basecamp and any other database...Full timePart timeLocal areaFlexible hoursWeekend workAfternoon shift
$18.57 - $23.23 per hour
...physicians and office administration to schedule and maximize utilization of time. Obtains pre-certification and authorizations from... ...records to assure efficient flow of patients through the office. Reviews promptly with physician routine issues, difficulties and...Full timeTemporary workPart timeWork at officeFlexible hours- ...Description Systems Administrator Project Specialist X98: $65,000 – $75,000 New Jersey... ...Directory and Microsoft 365 tenant - Review and respond to system-generated alerts... ...equipment, software and software licenses - Utilize RMM platform to deploy patches and...Work at officeLocal areaFlexible hours
$36.4 - $47.57 per hour
...vascular principles and theory, anatomy and pathology processes utilizing the most appropriate technique and positioning for optimal... ...all transcranial doppler findings with waveforms for physician review. Logs and charges all procedures performed accurately and routes...Full timeTemporary workPart timeImmediate startFlexible hours$44 - $48 per hour
...SCA Health in Langhorne, Bucks County, is seeking a Registered Nurse (RN) for the PreOp PACU team. This role involves comprehensive patient assessment, anesthesia management, and collaborating with healthcare teams to ensure quality care. The ideal candidate will have...Hourly pay$20 - $24 per hour
...Position Summary: SolomonEdwards is looking for a Title Specialist for one of its mortgage clients to perform tasks that require knowledge... ...excellent ability to work under time-sensitive deadlines. Review and manage daily pipeline reports. Take necessary steps to...Hourly payWork experience placementWork at officeLocal area- ...Langhorne, PA 19047, USA Residential Living Specialist The Residential Living Specialist... ...money management, public transportation utilization, and participation in meaningful and planned... ...laws. For further information, please review the Know Your Rights notice from the Department...
$90k - $110k
...Specialist, Technology Delivery Role Overview We are seeking a talented Specialist, Technology Delivery to oversee the successful... ...daily stand-ups, backlog refinement, sprint planning, and sprint reviews. Coach Agile teams beyond ceremony facilitation by...Full timeRemote work$70.5k - $94.4k
...succeeds.About the RoleThis position is responsible for performing RN duties using established guidelines to ensure appropriate level... ...the member/family among various sites to coordinate resource utilization and evaluation of services provided.Encourages member...Live inLocal areaWeekend work$85.6k - $106.8k
...Description Job Description The Program Specialist II will use expert skills to scope... ...escalate critical issues in timely manner Review documentation and deliverables from... ...phases of program lifecycle Experience utilizing MS Office Suite, SAP and other business...Temporary workWork experience placementFor subcontractorFlexible hours
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