Top 27 Clinical documentation & utilization review nurses Jobs in Wethersfield, Ct

Denial and Appeals RN / Clinical Resource Management
Hartford HealthCare Corp. —Wethersfield, CT
- Full-time
- Nursing
- Microsoft Excel
- RN License
Quick Apply
2d
Clinical Resource Mgmt Nurse / Clinical Resource Management
Hartford HealthCare Corp. —Wethersfield, CT
- Weekends as needed
- Nursing
- RN License
- 5 years
Quick Apply
Portal of Entry (ED) Utilization Management Nurse- 32hr- Onsite
Connecticut Children's Medical Center —Hartford, CT
- Nursing
- RN License
- Bachelor of Science
MDS PPS AGENCY
Preferred Professional Services (PPS) Agency —Wethersfield, CT
- Per diem
- Skilled nursing facility
- Mid-level
- Rehabilitation center
Center for Care Coordination-Team Lead Utilization Review Nurse- Full Time
Connecticut Children's Medical Center —Hartford, CT
- Full-time
- Nursing
- RN License
- Bachelor of Science
Utilization Management Registered Nurse RN
Trinity Health Of New England —Hartford, CT
- Full-time
- Hybrid work
- Nursing
- RN License
- Bachelor of Science
4d
MDS Coordinator Experience required within SNF LTC
Chestnut Hill Health & Rehabilitation Center —East Longmeadow, MA
- Urgently hiring
- Nursing
- Skilled nursing facility
- RN License
Quick Apply
14d
Denial RN DRG Appeal Writer2 / HIM Coding
Hartford HealthCare Corp. —Farmington, CT
- Full-time
- Nursing
- 6 years
- RN License
Quick Apply
4d
Denial RN DRG Appeal Writer2 / HIM Coding
Hartford HealthCare Corp. —Farmington, CT
- Full-time
- Nursing
- 6 years
- RN License
Quick Apply
4d
MDS Coordinator RN
iCare Health Network —Manchester, CT
- Full-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
8d
Denial RN DRG Appeal Writer2 / HIM Coding
Hartford HealthCare Corp. —Farmington, CT
- Full-time
- Nursing
- 6 years
- RN License
Quick Apply
4d
MDS Coordinator (RN) - Skilled Nursing
Hartford Hospital —Newington, CT
- Full-time
- Nursing
- Skilled nursing facility
- RN License
Quick Apply
MDS Coordinator
Autumn Lake Healthcare at New Britain —New Britain, CT
- Full-time
- RN License
- Mid-level
- LPN
- Referral program
Quick Apply
MDS Coordinator
Aaron Manor Nursing and Rehabilitation Center —Chester, CT
- $40 - $48 an hour
- Part-time
- Nursing
- Skilled nursing facility
- RN License
- Paid training
- 401(k)
Quick Apply
RN MDS Coordinator
Meriden Health and Rehab LLC —Meriden, CT
- Full-time
- Skilled nursing facility
- Patient monitoring
- RN License
- Health insurance
- Dental insurance
Quick Apply
MDS Coordinator
Parkville Care Center —Hartford, CT
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Disability insurance
- Health insurance
Quick Apply
13d
RN MDS Case Management
Cheshire House Nursing and Rehabilitation Center —Waterbury, CT
- Full-time
- Skilled nursing facility
- Mid-level
- Rehabilitation center
Quick Apply
MDS Coordinator Experienced!!!
Meriden Health & Rehab —Meriden, CT
- Full-time
- Anatomy knowledge
- Skilled nursing facility
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
MDS Coordinator
Fresh River Healthcare —East Windsor, CT
- Full-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
5d
MDS Director
Wadsworth Glen Health Care and Rehabilitation Center —Middletown, CT
- Up to $45 an hour
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Paid holidays
- Dental insurance
Quick Apply

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clinical documentation & utilization review nurses jobs near wethersfield, ct

Denial and Appeals RN / Clinical Resource Management

Hartford HealthCare Corp. -
Wethersfield, CT

Quick Apply

Job Details

Full-time
2 days ago

Qualifications

Microsoft Excel
RN License
Productivity software
Epic
Healthcare reimbursement methods
Negotiation

Full Job Description

Location Detail: 1290 Silas Deane Hwy Wethrsfld (10181)

Shift Detail: Monday through Friday 7a-330pm, no holidays and weekends

Work where every moment matters.

Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Department Description:

Integrated Care Partners (ICP) is a physician-led, clinically integrated health care network whose mission is to assist our members in providing the highest quality care at the most reasonable cost for our patients in the current, rapidly changing medical environment.

Position Summary:

The Denial and Appeals Nurse is an integral part of the Care Management team. Their focus is on the management of the payer denial and appeals process. The Denial and Appeals Nurse is responsible for appealing inappropriate denials through all levels of the appeals process. The Denial and Appeals Nurse is able to work autonomously and swiftly, managing a high volume of complex cases across all HHC system hospitals.

Key Areas of Responsibilities:

Follow standard work processes to manage denials and appeals
Ensure activities are completed within regulatory and payer timeframes
Develop and maintain collaborative relationships with internal and external stakeholders as needed to obtain additional information to properly formulate the clinical appeal and to resolve any issues that may arise during the appeals process
Partner with the Medical Director and Physician Advisor staff to compose factually sound appeal letters for denial reconsiderations utilizing clinical documentation and contract language
Maintain all documentation associated with the processing and handling of appeals to comply with regulatory standards and timeframes while maintaining an accurate, complete appeals record in the appropriate database
Assist in analysis and documentation of root cause for denials
Provide education to stakeholder groups on findings, analysis and mitigation strategies as needed
Work with multi-disciplinary team to identify denial / appeal trends and supports development of performance improvement strategies in response to identified patterns
Other duties as assigned.

Reports To: Manager, Clinical Resource Management

Qualifications

Education: Registered Nurse. Bachelors of Science in Nursing is preferred.

Experience: Five years of relevant case management, utilization management or managed care experience.Thorough understanding of Medicare, Medicaid, and Commercial reimbursement methodologies is preferred.

Licensure, Certification, Registration: Current State of Connecticut RN license is required. CCM (certified case manager), CPUM (certified professional in utilization management), or other relevant certification is preferred.

Knowledge, Skills and Ability Requirements:

Strong interpersonal and written / oral communication skills
Maintains a positive attitude in a fast-paced environment
Able to influence and negotiate
Critical thinking, astute assessment and confident in decision making
Knowledge of Interqual, MCG, or equivalent criteria and reimbursement guidelines
CT RN license required without restriction, to the extent allowed by State and Federal law.
Use of Microsoft Office including Word, Excel, and Power Point
Use of EPIC

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

Quick Apply

Refine Your Search

clinical documentation & utilization review nurses jobs in wethersfield, ct

Denial and Appeals RN / Clinical Resource Management

Clinical Resource Mgmt Nurse / Clinical Resource Management

Portal of Entry (ED) Utilization Management Nurse- 32hr- Onsite

MDS PPS AGENCY

Center for Care Coordination-Team Lead Utilization Review Nurse- Full Time

Utilization Management Registered Nurse RN

MDS Coordinator Experience required within SNF LTC

Denial RN DRG Appeal Writer2 / HIM Coding

Denial RN DRG Appeal Writer2 / HIM Coding

MDS Coordinator RN

Denial RN DRG Appeal Writer2 / HIM Coding

MDS Coordinator (RN) - Skilled Nursing

MDS Coordinator

MDS Coordinator

RN MDS Coordinator

MDS Coordinator

RN MDS Case Management

MDS Coordinator Experienced!!!

MDS Coordinator

MDS Director

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