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 Air Combat Effectiveness Consulting Group, LLC
- ...Denials Case Manager, RN The Denials Case Manager, RN appeals all denials using InterQual criteria and medical necessity. Collaboratively works with all members of the revenue cycle team and all types of payers to resolve denials, maximize accurate and timely reimbursement...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
- ...online and send your resume to ****@*****.***. POSITION SUMMARY The Manager of Care Management will supervise and direct all levels of Care Management team that includes RN Care Managers, Lead Care Management RN, Care Management Coordinators, Discharge...Suggested
- ...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
- ...hospital setting: 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...Full timeWork experience placementShift workDay shift
$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- ...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...
$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$34 - $45 per hour
...Case Manager (LVN/RN) (On-Field - Inland Empire) Department: HS - ICM Employment Type: Full Time Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Reporting To: Dourly Galvez Compensation: $34.00 - $45.00 / hour Description Astrana Health...Hourly payFull timeWork at office- ...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...
- 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...
- ...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...
- 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...
- ...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-...
- ...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...
- ...includes directing nursing care in a collaborative environment and ensuring quality outcomes. Candidates must hold a valid California RN license and have strong communication and leadership skills. Preferred qualifications include BCLS, ACLS certifications, 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 AHMC HealthCare
- 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, 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...
- ...California, is looking for a Registered Nurse responsible for delivering patient care through assessment, treatment, and evaluation. The RN will coordinate nursing care based on established clinical standards and collaborate with other health professionals to ensure...
- ...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-...
- ...POSITION SUMMARY The RN Utilization Management (RN UM) functions as a support liaisons for a variety... ...which may include: the e-TAR process, denials management, and the UM process.... ...assigned such as denials management and appeals in lieu of other UM duties. POSITION...Full time
- ...local standards that govern the facility and as directed by your management. ESSENTIAL DUTIES AND RESPONSIBILITIES Admitting,... ...Licensure Nursing Degree from accredited school or college Valid RN license in good standing Valid CPR and BLS card...Local areaImmediate startShift work
- Rose Senior Living - Avon is seeking a Program Administrator to manage and oversee the operations of residential homes for individuals with developmental disabilities. The ideal candidate will have a strong background in administering licensed services and possess exceptional...Flexible hours
$75k - $80k
...organization. About The Role Under the supervision of the Clinic RN, the Home Care Coordinator (LVN/RN) provides home-based nursing... ...agencies. Coordinates home care services as assessed by Case Management RN and approved by Primary Care Provider; coordinates home care...Live in$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$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...- ...Preferred Licenses/Certifications: Registered Nurse (RN) licensure in the state of practice: Required... ...on time, accurately, and in collaboration with staff members and management with minimal incidents of absence or unbalanced/short staffing events...Full timeWork experience placementShift workDay shift
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