A company is looking for a Nurse Specialist II, Clinical Denials.Key Responsibilities : Review medical record documentation for medical necessity issues and create detailed clinical analyses and appeal letters for denialsManage inventory, follow up on accounts, and provide feedback for ongoing trainingIdentify root causes, trends, and share findings with clients and staffRequired Qualifications : Licensed RNAt least 2 years' experience in an acute care hospitalThree to five years of experience in utilization review, case management, or related programsExperience using InterQual and Milliman healthcare criteria preferredExperience reviewing CMS LCD / NCD criteria preferred
Clinical Nurse Specialist - Neonatal ICU
The NICU Clinical Nurse Specialist (CNS) is responsible and accountable for the quality of nursing care provided in the NICU. Current certification by the State Board of Nursing as a Clinical Nurse Specialist. Providing policies, procedures, clinical orientation, staff development, mentoring, consul...
Clinical Nurse II - Venice
We believe the professional and clinical environments are enhanced when diverse groups of people with diverse ideas come together. Come join our Venice Family Clinic team as a Registered Nurse (RN). Current, active California Registered Nurse License. ...
Clinical Nurse Specialist (various Specialties)
CLINICAL NURSE SPECIALIST (VARIOUS SPECIALTIES)Print ()ApplyCLINICAL NURSE SPECIALIST (VARIOUS SPECIALTIES)Salary$131,356. LICENSE:A license to practice as a Registered Nurse and a certificate indicating that the person is qualified to use the title of Clinical Nurse Specialist, both issued by the ...
Registered Nurse/Clinical II, Operating Room Unit
The OR Registered Nurse is a licensed experienced professional supervised by the Nurse Manager/Nursing Director. An OR Registered Nurse is responsible for providing guidance, clinical expertise, and mentoring to members of the perioperative team within the specialty while optimizing available resour...
Utilization Management Nurse Specialist LVN II
The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve medically necessary referrals that meet established criteria. Utilizing considerable clinical judgement, independent analysis, critical-thinking skills and detailed knowledge and application of medical policie...
Registered Nurse/Clinical II, Emergency Department Unit
The Registered Nurse/Clinical II (CN II) is a licensed experienced professional supervised by the Clinical Supervisor/Clinical III (CN III), Nurse Manager/Nursing Director. Minimum one (1) year of recent nursing experience, preferably in an acute care setting as a registered nurse and for the depart...
Clinical Nurse Specialist - Neonatal ICU
Francis is dedicated to providing vital healthcare services for the 700,000 adults and 300,000 children who count on the hospital for high quality and compassionate medical care.Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Sur...
Enhanced Care Management Clinical Specialist II
The Enhanced Care Management (ECM) Clinical Specialist II is responsible for the management and oversight activities associated with L. Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse (RN); current and unrestrited California License. The positi...
Mgr . Clinical Nurse Specialist / Critical Care
Overview Purpose Statement/Position Summary: The Clinical Nurse Specialist (CNS) provides clinical leadership and expertise for population-based nursing care to integrate evidence based care, advance clinical practice, achieve optimal nurse-sensitive patient outcomes and facilitate transitions of ca...
Registered Nurse/Clinical II, Vascular Access
The Registered Nurse/Clinical II (CN II) is a licensed experienced professional supervised by the Clinical Supervisor/Clinical III (CN III), Nurse Manager/Nursing Director. Minimum one (1) year of recent nursing experience, preferably in an acute care setting as a registered nurse and for the depart...