RN Denials & Appeals Manager
Air Combat Effectiveness Consulting Group LLC
Air Combat Effectiveness Consulting Group, LLC is seeking a Denials Case Manager, RN to oversee appeals and ensure compliance with medical necessity standards. This role involves collaboration with different teams to maximize reimbursement and address denial trends. Ideal candidates should have significant acute care experience and a strong grasp of Utilization Management practices. A current California RN License and BLS certification are mandatory. #J-18808-Ljbffr
- ...Overview TheDenialsCaseManager, RN appeals alldenialsusing InterQual criteria and medical... ...Plan (PIP). According to the American Case Management Association Standard of Practice, Case... ...template for appeals includes reason for denial, diagnosis codes, MCG criteria used to support...Suggested
- ...of care. Conducts interdisciplinary care management rounds. Ensures collaboration between multidisciplinary... ...requirements as it relates to patient appeals (IM Letters, HINN letters), and Condition... ...requested. Minimum Qualifications Valid RN License Valid BLS Card Valid MAB...SuggestedWork experience placementImmediate start
- ...standard of patient care we strive for. Responsibilities Our Case Managers conduct case management on patients in the inpatient, intensive... ...processes for staff Handle responses to inpatient stay denials Monitor inpatient census to ensure that patients are correctly...Suggested
- ...****@*****.***. POSITION SUMMARY The purpose of the Case Manager position supports the physician and interdisciplinary team in... ...with physicians. The role reflects appropriate knowledge of RN scope of practice, current state requirements, CMS Conditions of...SuggestedNight shift
- ...: Preferred Licenses/Certifications: Registered Nurse (RN) licensure in the state of practice: Required Cardiopulmonary... ...time, accurately, and in collaboration with staff members and management with minimal incidents of absence or unbalanced/short staffing events...SuggestedFull timeWork experience placementShift workDay shift
- ...compliance with safety procedures, and maintaining customer satisfaction during the blood collection process. Candidates must have an RN license, BLS certification, and a minimum of three years of clinical experience. This role is crucial for maintaining high standards...Full timeNight shift
- ...local standards that govern the facility and as directed by your management. ESSENTIAL DUTIES AND RESPONSIBILITIES Admitting, transferring... ...Licensure Nursing Degree from accredited school or college Valid RN license in good standing Valid CPR and BLS card Qualifications /...Local areaImmediate startShift workNight shiftWeekend work
- ...for patient care through the nursing process. Candidates must be graduates of an accredited nursing school with a current California RN license and have at least one year of acute experience. The successful applicant will direct nursing care and collaborate across disciplines...
- ...collaboration with professional disciplines to ensure effective patient care delivery. The ideal candidate will have a current California RN license and be a graduate of an accredited nursing program, proficient in communication and teamwork, with at least one year of acute...
- ...AHMC HealthCare in Monterey Park, California is seeking a Registered Nurse (RN) responsible for delivering patient care through assessment, diagnosing, planning, implementing, and evaluating nursing processes. The ideal candidate will have graduated from an accredited...
- ...and collaborating with other disciplines for effective delivery. The ideal candidate will have a graduate nursing program certificate, a current California RN license, and relevant certifications. Strong communication skills in English are essential. #J-18808-Ljbffr...
$49.86 - $76.69 per hour
...working relationships within the nursing team and interdisciplinary units. The position requires an Associate degree in nursing, a current RN licensure in California, and at least one year of acute care experience is preferred. The hourly wage ranges from $49.86 to $76.69,...Hourly pay- ...serve in the Resource nurse role as required. Applicants must be graduates of accredited nursing schools and hold a valid California RN license. Strong communication and leadership skills are essential. Experience in acute care and chemo is preferred. #J-18808-Ljbffr...
- ...Nurse to provide critical care for acutely ill patients at Arcadia Hospital. The role requires an Associate degree in nursing, current RN licensure in California, and BLS/ACLS certifications. You will work collaboratively in a dynamic team environment, ensuring high-...
- ...safety protocols, medication administration, and support for the core values of San Gabriel Valley Medical Center. A current California RN License and BLS, ACLS certifications are required. Bilingual skills (English/Spanish/Vietnamese/Chinese) are preferred. #J-18808-...
- ...Air Combat Effectiveness Consulting Group, LLC is seeking a Case Manager to evaluate admission appropriateness and coordinate patient... ...with healthcare teams. The ideal candidate must possess an active RN License in California and at least one year of experience as a Case...
- ...through assessment, planning, implementation, and evaluation, ensuring a high standard of care. Candidates must have a current California RN license, proficiency in communication, and preferably one year of acute care experience. Certifications in BCLS and ACLS are required...
- ...Air Combat Effectiveness Consulting Group, LLC is seeking a Registered Nurse (RN) in Monterey Park, California, responsible for the delivery of comprehensive patient care, collaborating with professionals to achieve positive patient outcomes. The ideal candidate will...
- ...A fast-growing healthcare provider in California seeks an experienced Case Manager II – RN to manage a caseload of moderate to high-complexity members. This role involves conducting assessments, developing individualized care plans, and coordinating services while working...Remote workFlexible hours
- ...Case Manager JOB SUMMARY: The Case Manager uses InterQual criteria to evaluate the appropriateness of admissions, concurrent stay and... ...performance improvement plan. EDUCATION, EXPERIENCE, TRAINING RN License in the State of California (Required) Certified Case...
- ...through assessment, planning, and evaluation while collaborating with interdisciplinary teams. Candidates must have a current California RN license and at least one year of acute care experience. This position supports the organization's mission and requires strong...
$88.36k - $100k
...Case Manager II, RN Huntington Beach Office - Huntington Beach, CA 92647; Arcadia Office - Arcadia, CA 91007 Overview Salary Range $88,355.00 - $100,000.00 Salary Position Type Full Time Description Remote in California only Are you ready to make a...Full timeWork at officeRemote work- ...resident conditions, and completing documentation. Candidates are preferred to have a Bachelor's Degree in Nursing or Social Work and an RN, LVN, or LPN license. Two years of clinical experience is also preferred. The position offers a dynamic work environment with...
- ...Sca-Health- is seeking an experienced Registered Nurse (RN) PACU in California to assess patient status and develop perianesthesia plans of care. Candidates should be graduates of an accredited nursing school, with current licensure and BLS/ACLS certifications. Your work...
$31 - $45 per hour
...Astrana Health Management is seeking a Case Manager (LVN or RN) in Monterey Park, CA. This full-time position involves working standard hours M-F and offers training for individuals without prior case management experience. The ideal candidate will coordinate care plans...Hourly payFull timeWork at officeRemote work$58 - $62 per hour
...part of the care plan development and implements prior to discharge of the patient. Qualifications: Current and valid state RN license. Minimum of 1 year of recent acute care experience in an institutional setting. Basic Life Support (BLS), with...Monday to FridayFlexible hoursShift work$49.86 - $76.69 per hour
...Nurse to provide safe therapeutic care to acutely ill patients. Candidates must have an Associate's degree in nursing and a current RN license in California, with experience in acute care preferred. The role includes responsibilities such as medication administration,...Hourly pay$31 - $45 per hour
...Case Manager (LVN/RN) (On-Field - Orange County) Department: HS - ICM Employment Type: Full Time Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Reporting To: Kylie Perine Compensation: $31.00 - $45.00 / hour Description Astrana Health is looking for a RN/...Hourly payFull timeWork at office$75k - $80k
...organization. About The Role Under the supervision of the Clinic RN, the Home Care Coordinator (LVN/RN) provides home-based nursing... ...external agencies. Coordinates home care services as assessed by Case Management RN and approved by Primary Care Provider; coordinates home care...Live in$75k - $80k
A healthcare organization is seeking a Home Care Coordinator in Alhambra, CA. This role involves providing home-based nursing services and coordinating care for elderly participants. Candidates should hold an Associate's degree in nursing or equivalent, with at least two...
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