-
Nurse Extern PRN
5 days ago
The Woman's Hospital of Texas Houston, United StatesIntroduction · Do you have the PRN career opportunities as a(an) Nurse Extern PRN you want with your current employer? We have an exciting opportunity for you to join The Woman's Hospital of Texas which is part of the nation's leading provider of healthcare services, HCA Healthca ...
-
PRN ER Nurse
3 weeks ago
The Woodlands Specialty Hospital The Woodlands, United StatesJob Title: · Emergency Room Nurse · Department: · Emergency Room · Reports To: · ER Nurse Manager · FLSA Status: · Non-exempt · Revision Date: · 12/14/2022 · Position Summary · The Emergency Room Nurse provides direct and indirect patient care in the emergency care setting and is ...
-
RN Endo Nurse PRN
2 weeks ago
MEC Endoscopy Houston, United States SGRDescription · Introduction · Do you have the PRN career opportunities as a RN Endo Nurse PRN - Surgery Center you want with your current employer? We have an exciting opportunity for you to join MEC Endoscopy which is part of the nation's leading provider of healthcare services, ...
-
Registered Nurse Antepartum PRN
5 days ago
The Woman's Hospital of Texas Houston, United StatesIntroduction · Do you currently have an opportunity to make a real impact with your work? With over 2,000 sites of care and serving over 31.2 million patient interactions every year, nurses at The Woman's Hospital of Texas have the opportunity to make a real impact. As a(an) Regi ...
-
Registered Nurse PICU PRN
3 weeks ago
The Woman's Hospital of Texas Gridiron, United StatesDescription · IntroductionThe Woman's Hospital of Texas is committed to investing in the latest technology enabling nurses to work more efficiently. Are you passionate about delivering patient-centered care? Submit your application for Registered Nurse PICU PRN position and spen ...
-
Registered Nurse Operating Room PRN
6 days ago
HCA Houston Healthcare Northwest Houston, United StatesIntroduction · HCA Houston Healthcare Northwest is committed to investing in the latest technology enabling nurses to work more efficiently. · Are you passionate about delivering patient-centered care? · Submit your application for Registered Nurse Operating Room PRN position and ...
-
Registered Nurse Emergency Room PRN
6 days ago
The Woman's Hospital of Texas Houston, United StatesIntroduction · Are you looking for a work environment where diversity and inclusion thrive? Submit your application for our PRN Registered Nurse Emergency Room opening with The Woman's Hospital of Texas today and find out what it truly means to be a part of the HCA Healthcare tea ...
-
CHRISTUS Corp Houston Office and TLRA Revenue Cycle Houston, United States PRNJob Description · Summary: · Responsible for the management and communication of denials/appeals received from third party payers, managed care companies, and/or government entities/auditors related to medical necessity and/or level of care. This associate will be a liaison and ...
-
CHRISTUS Corp Houston Office and TLRA Revenue Cycle Houston, United States PRNJob Description · Summary: · Responsible for the management and communication of denials/appeals received from third party payers, managed care companies, and/or government entities/auditors related to medical necessity and/or level of care. This associate will be a liaison and ...
-
Registered Nurse Rapid Response PRN
3 weeks ago
HCA Houston Healthcare West Houston, United StatesIntroduction · Do you have the PRN career opportunities as a(an) Registered Nurse Rapid Response PRN you want with your current employer? We have an exciting opportunity for you to join HCA Houston Healthcare West which is part of the nation's leading provider of healthcare servi ...
-
RN Endo GI Nurse PRN
1 week ago
Physicians Ambulatory Surgery Center Houston, United StatesIntroduction · Do you have the PRN career opportunities as an RN Endo GI Nurse PRN - Surgery Center you want with your current employer? We have an exciting opportunity for you to join Physicians Ambulatory Surgery Center which is part of the nation's leading provider of healthca ...
-
RN Endo GI Nurse PRN
1 week ago
Physicians Ambulatory Surgery Center Careers Houston, TX, United States Full timeDescription · Introduction · Do you have the PRN career opportunities as an RN Endo GI Nurse PRN - Surgery Center you want with your current employer? We have an exciting opportunity for you to join Physicians Ambulatory Surgery Center which is part of the nation's leading pro ...
-
Registered Nurse Emergency Room PRN
3 weeks ago
HCA Houston Healthcare Medical Center Houston, United States HOSDescription · HCA is dedicated to the growth and development of our colleagues. We will provide you the tools and resources you need to succeed in our organization. We are currently looking for an ambitious Registered Nurse for the Emergency Room to help us reach our goals. Unlo ...
-
Registered Nurse RN PACU PRN
5 days ago
HCA Houston Healthcare Medical Center Houston, United States HOSDescription · Introduction · Do you currently have an opportunity to make a real impact with your work? With over 2,000 sites of care and serving over 31.2 million patient interactions every year, nurses at HCA Houston Healthcare Medical Center have the opportunity to make a rea ...
-
Nurse Extern PRN
1 month ago
HCA Houston Healthcare Mainland Texas City, United States Full timeDescription · Introduction · Do you have the PRN career opportunities as a Nurse Extern PRN you want with your current employer? We have an exciting opportunity for you to join HCA Houston Healthcare Mainland which is part of the nation's leading provider of healthcare services, ...
-
Nurse Extern Prn
5 days ago
The Woman's Hospital of Texas Houston, United States**Introduction**: · Do you have the PRN career opportunities as a(an) Nurse Extern PRN you want with your current employer? We have an exciting opportunity for you to join The Woman's Hospital of Texas which is part of the nation's leading provider of healthcare services, HCA Hea ...
-
Registered Nurse RN Cardiac Cath Lab PRN
3 weeks ago
HCA Houston Healthcare Medical Center Houston, United States HOSDescription · Introduction · Do you have the PRN career opportunities as a(an) Registered Nurse RN Cardiac Cath Lab PRN you want with your current employer? We have an exciting opportunity for you to join HCA Houston Healthcare Medical Center which is part of the nation's leadin ...
-
Registered Nurse RN Pre-Admit Testing PRN
3 weeks ago
Texas Orthopedic Hospital Southgate, United StatesDescription · IntroductionDo you have the PRN career opportunities as a(an) Registered Nurse RN Pre-Admit Testing PRN you want with your current employer? We have an exciting opportunity for you to join Texas Orthopedic Hospital which is part of the nation's leading provider of ...
-
Registered Nurse Case Manager PRN
1 week ago
HCA Houston Healthcare Northwest Houston, United States HOSDescription · Do you want to be a part of a family and not just another employee? Are you looking for a work environment where diversity and inclusion thrive? Submit your application today and find out what it truly means to be a part of a team. · We value your contributions. Ou ...
-
Registered Nurse House Supervisor PRN Nights
3 weeks ago
HCA Houston Healthcare Medical Center Houston, United States HOSIntroduction · Do you have the career opportunities as a(an) Registered Nurse House Supervisor PRN Nights you want with your current employer? We have an exciting opportunity for you to join HCA Houston Healthcare Medical Center which is part of the nation's leading provider of h ...
Appeals AND Grievance Nurse Registered Nurse II PRN - Houston, United States - Christus Health
Description
Summary:
Responsible for the management and communication of denials/appeals received from third party payers, managed care companies, and/or government entities/auditors related to medical necessity and/or level of care.
The Clinical Appeals Nurse will review each case identified/referred for appeal based on Milliman Care Guidelines (MCG), InterQual, and/or other relevant guidelines, determined the viability of the appeal, and manage the appeal process.
The Clinical Appeals Nurse is responsible for appealing all inappropriate denials through all possible levels of the appeal process.The RN Clinical Appeals Nurse will actively manage, maintain and communicate denial/appeal activity to appropriate stakeholders, and report suspected or emerging trends related to payer denials.
Working with Case Management leadership, this individual will orchestrate education and other performance improvement initiatives to impact clinical quality, improve efficiency and mitigate lost revenue related to medical necessity denials.
Key Performance and trends related to denials/appeals will be reported to the facility.Focuses on the review and analysis of governmental denial rationales and provides appropriate medical necessity appeal services
Review governmental contractors response letter in comparison to the medical records
Communicates with facility regarding missing or insufficient medical documentation
Review medical documentation for adherence to Medicare guidelines relating to inpatient services (or other Medicare issues) and draft appropriate appeal letters based upon professional clinical opinion as to the medical necessity of the services provided
Research issues using federal or law, federal regulations, and relevant CMS policies Communicates with members of the healthcare team identifying root causes for potential denials
Communicates with the CMO/VPMA regarding appeals and obtain signature for appeals
Assures all discussions and appeals are filed timely
Completes data entry in the Denial database for tracking, trends, and analysis
Requirements:
Associate's Degree in Nursing
RN License in state of employment or compact
Work Type:
Per Diem As Needed
EEO is the law - click below for more information:
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at
