Appeals and Grievances Clinical Specialist - RN or LPN
A company is looking for an Appeals and Grievances Clinical Specialist - RN or LPN, 100% Remote.Key ResponsibilitiesManage clinical case development and resolution for member and provider complaintsPrepare cases for Medical Director Review and external appeals processesEnsure compliance with Federal and State regulations while managing caseloadsRequired QualificationsMust be an RN, LPN, or Dental HygienistBachelor's degree preferredExperience in clinical practice, appeals & grievances, or utilization managementUnderstanding of Utilization Review Guidelines and related regulationsAbility to work with care management systems and multiple computer applications
Clinical Coordinator III (RN) - Hematology & Oncology (Outpatient)
A Clinical Coordinator III (RN) for is needed to provide patient care and education in an outpatient clinical setting for Melanoma/Sarcoma subspecialty program within the Division of Medical Hematology/Oncology at Columbia University Irving Medical Center. Perform comprehensive nursing assessment of...
Appeals and Grievances Supervisor
A company is looking for a Supervisor, Appeals & Grievances - Commercial. ...
Licensed Practical Nurse (LPN) - Float
Administer and document medication under a physician’s order and follows the five (5) medication rights and reduce the potential for medical error. Update and maintain all electronic patient records and assist in transitioning hard copy records to digital format. Record patient information suc...
Clinical Specialist, Wound Care Supplies RN / LPN
Provide clinical expertise and support to nursing homes and long-term care facilities in the management of wounds and wound-related conditions. Asure Wound Solutions offers a competitive salary and benefits package for our Clinical Specialists, Wound Care Supplies. Asure Wound Solutions is seeking a...
Grievance and Appeals Specialist, Clinical
Investigates and coordinates the resolution of routine and complex grievances and appeals according to defined processes and procedures ensuring that required timeframes and regulatory requirements are met, accurate and timely follow up is completed and activities are documented as required. Collabo...
LPN Clinical Coordinator - Transgender and Non-Binary Health - Hybrid Role
Are you an LPN or RN with care coordination experience with a passion for serving Trans + Non-Binary clients?. Known equally for our unique and effective model of care as well as our community-oriented mission, we strive to provide the comprehensive care and access to services our members need. Clin...
RN Clinical Manager / PSM - Registered Nurse
Qualified candidates will have prior Clinical Manager or Patient Service Manager experience within a Certified Home Health Agency, will have extensive knowledge of OASIS Documentation Review, Admissions, Coordination of Care and ensuring patient continuum of care. Ability to work with mathematical c...
RN or LPN Bilingual Spanish FQHC
A healthcare network in New York City is currently seeking a Spanish-speaking, licensed Registered Nurse (RN) to join one of their outpatient facilities in Manhattan. Performing clinical procedures, such as but not limited: injections, phlebotomy, EKG, dipstick urinalysis, finger stick blood tests, ...
Manager, Grievance and Appeals, RN
Ensures the accuracy and integrity of data collection and reporting systems to support analysis and reporting of grievances and appeals data for operations and for required CMS and DOH reporting. Ensures regulatory compliance and timely processing for the Medicare and Medicaid appeal and grievance p...
RN Wound Care Specialist
Collects, and analyzes process and outcomes data related to nursing skin and wound care utilizing internal and external metrics and benchmarks. Develop plan of care for resident with a current pressure sore, or evaluated as high risk for the development of pressure sores. Identifies opportunities an...