Find Jobs Showing 1–10 of 73,600 jobs
That job is no longer available. Here are some results that may be similar to the job you were looking for: Dismiss
Appeals AND Grievance Registered Nurse II - Tlra 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. This associate will be a liaison and point of contact for clinical denials and appeal inquiries. 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.
Responsibilities:
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:
Full Time
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 .
Posted 4 hours ago Staff Pharmacist. Walmart A Staff Pharmacist at Walmart is at the forefront of patient communications, listening and developing relationships with those that seek our quality, heartfelt care. If you love talking to patients and advocating for their wellbeing, then this position is perfect for you. You will be empowered to share your clinical knowledge and work to the top of your license. Come ready to be a community leader — and a leader among the pharmacy staff. The pharmacy environment is fast paced and equipped with the resources and technology you need to succeed. Your biggest tool will be your heart for human connection and wellness. Come ready to truly tap into your years of training as you create moments of care. You’ll really wow us if… - You’re an advocate of patient-centered care. You easily adapt to a patient base from a myriad of backgrounds and medical concerns, removing barriers for all patients to be healthier and happier. - You’re accurate and consistent in all areas of patient care, from counseling patients to processing prescriptions to administering immunizations. - You’re passionate about community involvement and enjoy doing outreach and events, including regular Wellness Days. You’ll make an impact by… - Truly understanding the business, from inventory control to cost savings for patients to compliance. - Modeling and providing guidance to the pharmacy staff on proper customer service approaches, including techniques to make sure concerns are successfully resolved. - Using tools, data and personal conversations to understand your community and common concerns and stay up to date on emergent and urgent health issues therein. The above information has been designed to indicate the general nature and level of work performed in the role. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job. The full Job Description can be made available as part of the hiring process. Benefits & Perks: Beyond competitive pay, you can receive incentive awards for your performance. Other great perks include 401(k) match, stock purchase plan, paid maternity and parental leave, PTO, multiple health plans, and much more. Equal Opportunity Employer Walmart, Inc. is an Equal Opportunity Employer – By Choice. We believe we are best equipped to help our associates, customers, and the communities we serve live better when we really know them. That means understanding, respecting and valuing diversity- unique styles, experiences, identities, ideas, and opinions – while being inclusive of all people. Provides pharmaceutical care to Customers, including processing and accurately dispensing prescription orders, counseling Customers regarding health care and prescription medication needs, maintaining confidential information, maintaining controlled medication and required documentation. Demonstrates up-to-date expertise and applies this to the development, execution, and improvement of action plans by providing expert advice and guidance to others in the application of information and best practices; supporting and aligning efforts to meet customer and business needs; and building commitment for perspectives and rationales. Provides and supports the implementation of business solutions by building relationships and partnerships with key stakeholders; identifying business needs; determining and carrying out necessary processes and practices; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and adapting to competing demands, organizational changes, and new responsibilities. Models, enforces, and provides direction and guidance to Associates on proper Customer service approaches and techniques to ensure Customer needs, complaints, and issues are successfully resolved within Company guidelines and standards. Models compliance with company policies and procedures and supports company standards of ethics and integrity by incorporating these into the development and implementation of business plans; using the Open Door Policy; and demonstrating and assisting others with how to apply these in executing business processes and practices. Ensures compliance with Company and legal policies, procedures, and regulations for assigned areas by analyzing and interpreting reports, implementing and monitoring loss prevention and safety controls, overseeing safety, operational, and quality assurance reviews, developing and implementing action plans, and providing direction and guidance on executing Company programs and strategic initiatives. Maintains confidential information, documentation, and assigned records as required by Company policies, and local, State, and Federal guidelines. Provides comprehensive patient care to customers by processing and accurately dispensing prescription orders; administering immunizations; and administering other programs developed by Walmart, in compliance with Board of Pharmacy statutes/regulations. Quality Patient Care-Facility: Creates a culture of patient care, safety, and accuracy. Communicates clear expectations regarding quality of care and patient safety. Ensures others are held accountable for following standard operating procedures (SOP) and achieving expected quality and patient safety goals. Ensures counseling (providing information related to the health service provided) occurs on new therapy (new items) and as requested by patients or required by practice or state regulations, including appropriate documentation. Analyzes and identifies areas of improvement needed and implements intervention steps to improve team knowledge and focus on patient safety and risk reduction. Promotes reporting and transparency of errors whether actual or patient perceived. Writes timely and effective plans of action focused on identification and correction of root cause. Compliance Focused Execution-Facility: Creates and fosters an environment centered on health care compliance execution. Actively communicates, trains, and guides the processes for completion and follow-up on compliance initiatives to associates within Health & Wellness and other associates as applicable to the respective health care business. Implements compliance initiatives and priorities and monitors compliance execution by others. Ensures appropriate operational execution of billing procedures, HIPAA compliance adherence, and Standard Operating Procedures (SOP). Utilizes auditing processes to identify compliance issues and implement processes for improvement. Leadership Expectations Respect for the Individual: Embraces differences in people, cultures, ideas, and experiences; creates a workplace where associates feel seen, supported and connected through culture of belonging; creates equitable opportunities for associates to thrive and perform; helps to attract the best, diverse talent. Respect for the Individual: Works as a team; builds strong and trusting relationships; communicates with impact, energy, and positivity to motivate and influence. Respect for the Individual: Strengthens the team by helping, developing and mentoring others; recognizes others’ contributions and accomplishments. Act with Integrity: Maintains and promotes the highest standards of integrity, ethics and compliance, models the Walmart values to support and foster our culture; holds oneself and others accountable; supports Walmart’s goal of becoming a regenerative company by making a positive impact for associates, customers, members, and the world around us Act with Integrity: Acts in a selfless manner and is consistently humble, self-aware, honest, fair, and transparent. Service to the Customer/Member: Delivers results while putting the customer first. Service to the Customer/Member: Makes decisions based reliable information; balances short- and long-term priorities; and considers how own work impacts the team’s ability to deliver on our purpose for all stakeholders. Strive for Excellence: Displays curiosity and a desire to learn; takes calculated risks; and demonstrates courage and resilience. Strive for Excellence: Drives continuous improvements; is open to and uses new technologies and skills; and supports others through change.#LI-JL2 At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more. You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable. For information about PTO, see notices. Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms. For information about benefits and eligibility, see One.Walmart. The annual salary range for this position is $98,000.00-$172,000.00* *This pay range is for a 40 hours/week schedule. Weekly scheduled hours are determined individually and the ranges for different scheduled hours are prorated based on the percentage of 40 hours. E.g., the range for a 36 hours/week schedule, which is 90% of 40 hours, is 90% of the above range. Additional compensation includes annual or quarterly performance bonuses. Minimum Qualifications... Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications. Bachelor's Degree in Pharmacy or PharmD degree, or equivalent FPGE (NABP). Pharmacy license (by job entry date). Completion of an ACPE Accredited Immunization training program (for example, APhA, Pharmacy School Curriculum, State Pharmacy Association sponsored). Preferred Qualifications... Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications. Primary Location... 9131 College Pkwy Ste 101, Fort Myers, FL 33919-4827, United States of America Posted 4 hours ago Pharmacy Manager. Walmart Quality Patient Care-Facility: Creates a culture of patient care, safety, and accuracy. Communicates clear expectations regarding quality of care and patient safety. Ensures others are held accountable for following standard operating procedures (SOP) and achieving expected quality and patient safety goals. Ensures counseling (providing information related to the health service provided) occurs on new therapy (new items) and as requested by patients or required by practice or state regulations, including appropriate documentation. Analyzes and identifies areas of improvement needed and implements intervention steps to improve team knowledge and focus on patient safety and risk reduction. Promotes reporting and transparency of errors whether actual or patient perceived. Writes timely and effective plans of action focused on identification and correction of root cause. Posted 4 hours ago New Grad RN Residency - MWH Critical Care Center/ICU. Mary Washington Healthcare The Level I Novice Registered Nurse is an entry-level nurse who has graduated from an accredited nursing program and does not have clinical experience as a Registered Nurse. The Level I MWHC nurse is responsible for mastering the knowledge and skills necessary for competent Level II nursing practice within one year of beginning employment at Mary Washington Healthcare. Posted 4 hours ago Registered Nurse Grand Prairie Freestanding ER. Medical City Arlington Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a Registered Nurse Grand Prairie Freestanding ER today with Medical City Arlington. Posted 4 hours ago Phlebotomist (Inpatient) South Shore Health b. Labels all specimen tubes following established procedure: Date and time of draw and Phlebotomist initials when not using Bar Code Labels generated by Automated Patient Identification system. c. When using Automated Patient Identification system, scan the barcode on your employee badge and enter your password into the handheld. d. Select patient on handheld then scan patients' armband to bring up that patients' orders. Highlight tests to be drawn, draw patient, select method that you used (venipuncture, heelstick, etc.) hold handheld over label printer to print labels. (Only labels for that patient will print) e. All label printing and application to tubes is to be done at the bedside. 3. Determines priority of STAT draws. Insures timely transport of all patient specimens to lab for testing. a. Prioritizes STAT requests. Draws STATs within 10-15 minutes of request. b. Draws severe trauma and/or disaster patients immediately. c. Ensures that STATs are transported to lab on a priority bases immediately for serious cases: Trauma, disaster; within 15 minutes of draw for other STATs. Hourly for routines. 4. Utilizes computers as appropriate in completing assigned functions. a. Verifies all information for accuracy. b. Performs order entry with no errors. c. Generates collection lists (NCC list ) and can add on or cancel tests. 5. Organizes assigned work and accurately completes work load statistics. a. Draws all assigned patients by the end of shift. b. Print NCC lists periodically and check to see that all patients listed are accounted for. 6. Helps co-workers when needed and communicates with laboratory departments when needed to ensure an orderly work flow. a. Assists co-workers with blood-drawing procedures on morning rounds before returning to phlebotomy station. b. Informs floors of patients not drawn for any reason at time of attempt. c. Informs Supervisor of problems in obtaining specimens for any reason. 7. Under supervision will help in the training of new employees and student interns at SSH&EC in the performance of phlebotomy duties. a. Works with new employees to assist in training of departmental procedures. b. Acts as a resource to new employees. 8. Follows all organizational and department or unit policies and procedures. 9. Readily accepts changes in assignment. Performs work level of equal skill and responsibility as needed. May be required to do work of lesser responsibility when the workload of the department so requires. 10. Will act as a receptionist, greet patients and answer phones in the outpatient lab when required. a. Is courteous and friendly to patients. b. Answers phones in a prompt and courteous manner and by stating name and department. 11. Is responsible for the daily cleaning of equipment and maintaining neatness throughout the department. a. Keep Phlebotomy baskets neat and check periodically for any outdated tubes. b. Will replenish phlebotomy baskets upon completion of shift. c. Will ensure that all safety and waste containers are disposed of properly. d. Maintain stock in Phlebotomy room & Drawing room. e. Maintain cleanliness of Phlebotomy rooms, Break room & Storage rooms at all times f. Cleans work areas at the beginning and end of each shift. 12. Records daily temperature of refrigerator. a. Notifies Supervisor if temperature falls outside of established limits. 13. Technology – Is receptive to technological solutions to work processes and practices. 14. Safety Awareness – Fosters a “Culture of Safety” through personal ownership and commitment to a safe environment as stated in the Safety Management Program Manual, Infection Control Manual and Phlebotomy Policies & Procedure Manual. The employee is knowledgeable of who the Hospital Safety Officer is. a. Consistently adheres to established Laboratory and Hospital policies for Universal Precautions and Safety Procedures. b. When handling blood/and or body fluids, Personal Protective Equipment (PPE) will be utilized in order to minimize exposure to infectious diseases. c. Wears gloves, gowns, goggles, or masks as required. d. Disinfects & cleans work area at the beginning and end of each shift. e. Knows where to find Material Safety Data Sheets (MSDS) for any item used in job performance. JOB REQUIREMENTS Minimum Education - Preferred Equivalent of four (4) years of high school education preferred. Minimum Work Experience One (1) year of full time experience preferred. Certifications Certified or certified eligible with National Phlebotomy Association preferred. Posted 4 hours ago CNA/Healthcare Tech - Atrium Health Pineville Progressive/Intermediate Unit FTDays. Atrium Health The Nurse Aide/Healthcare Technician assists in providing patient care under the direct supervision of the Registered Nurse. Assists in maintaining a clean, safe patient environment and performs job responsibilities in a safe manner. Maintains clinical and professional competencies as appropriate to the needs of the patient population served. Posted 6 hours ago Salon Hair Stylist (Licensed Hair Stylist) Hair Cuttery As a Salon Hair Stylist, you will enjoy competitive pay, flexible scheduling, and abundant opportunities for career advancement, alongside access to top-notch education and benefits. Your earnings potential ranges from $15 to $40+ per hour based on your ability to build a loyal clientele. Join a dynamic team where stylists thrive and careers take off. Posted 6 hours ago Center - Based Behavior Technician - Entry Level . Centria Autism We are looking for candidates who are passionate about helping children with autism reach their full potential. You will need to be patient, compassionate, and able to work well in a team environment. We will provide comprehensive training so that you are equipped and empowered to help each child, even if you don’t currently have experience. Children can be unpredictable and potentially confrontational, so this role is not for the weak of spirit, mind, or body. Part of the joy of working with kids is exercise! Our clients move, so you need to be comfortable standing, walking, sitting, grasping, reaching, bending, kneeling, crouching, squatting, lifting, and at times carrying children or objects that weigh up to 50 pounds. Posted 6 hours ago Special Forces 18X. U.S. Army *18X OFFERS A PATH TO CITIZENSHIP. While citizenship is a requirement for passing a secret security clearance, Lawful Permanent Residents can immediately begin 18X training. If you've had a valid Green Card (officially known as an I-551 Permanent Resident Card) for at least six months, you can apply for expedited naturalization and candidacy for the Special Forces through MOS 18X. Work with a recruiter to get started. Posted 6 hours ago Description
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 point of contact for clinical denials and appeal inquiries. 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.
Responsibilities:
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:
Full Time
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 .
View more.. 
