- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... the safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing… more
- Trinity Health (Farmington Hills, MI)
- …NPR) of a Patient Business Services (PBS) center. Serves as part of a team of clinical payment resolution colleagues at an assigned PBS location responsible ... and determining root causes of clinical denials. Responsible for leveraging clinical knowledge and standard procedures to track appeals through first,… more
- Kepro (Indianapolis, IN)
- …ensure timely and complaint processing. They will be a crucial resource for the Appeals Team , contribute to quality initiatives, and champion continuous care for ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...Appeals Nurse - LPN/RN to join our growing team . Job Summary: Our Utilization Management Appeals … more
- CareFirst (Baltimore, MD)
- …of the Clinical Medical Claims Review, Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. ... May lead our Commercial team and our Government...week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple strategic clinical … more
- Abbott (Plano, TX)
- …Our 114,000 colleagues serve people in more than 160 countries. **Sr. Appeals Specialist, Patient Therapy Access Team ** **Position Location: 6600 Pinecrest ... **Plano, TX** currently has an opportunity for a **Sr. Appeals Specialist** . This role is responsible for facilitating...procedures or forms of therapy based on physician recommendation. Lead efforts to develop programs that assist with multiple… more
- LA Care Health Plan (Los Angeles, CA)
- …in a consistent and accurate manner. This position will focus on quality review of non- clinical grievance and appeals cases for all line of business (LOB) to ... Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job...executing, tracking, and assessing targeted and random audits for non- clinical grievance and appeal case documentation. Ensure A&G Non-… more
- Centene Corporation (Baton Rouge, LA)
- …and appeal decisions. + Act as subject matter expert regarding grievances and appeals . + Lead Appeals and Grievance Committee **Education/Experience:** ... be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team . Centene is a diversified,… more
- Centene Corporation (Tempe, AZ)
- …and appeal decisions. * Act as subject matter expert regarding grievances and appeals . * Lead Appeals and Grievance Committee Education/Experience: ... be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team . Centene is a diversified,… more
- Trinity Health (Farmington Hills, MI)
- …practices, and decisions. Performs daily activities as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned ... of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of the Payment Resolution... denials). Serves as part of the Payment Resolution team at an assigned PBS location responsible for ensuring… more
- Trinity Health (Farmington Hills, MI)
- …NPR) of a Patient Business Services (PBS) center. Serves as part of a team of coding payment resolution colleagues at a PBS location responsible for identifying and ... Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing… more
- Glens Falls Hospital (Glens Falls, NY)
- …MCC's and CC's for reimbursement. In collaboration with Hospital External Review Team (HERT) members, coordinates reviews and responds to internal and external ... but with emphasis on Inpatient Coding. Collaborates with Professional Coders, Clinical Document Improvement Specialists, "Scrubber" Edit Specialists and Providers to… more
- Catholic Health Services (Melville, NY)
- …time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! ... an operations' liaison, collaborating with various entities including payers, clinical , financial and/or operational departments. Duties/Responsibilities: Conducts data analysis… more
- Healthfirst (NY)
- …preps completed case files for clinical review. + Notifies team lead of identified patterns of appeals , claim errors, configuration issues or other ... + Prepare cases for the clinical team by gathering documentation, loading...Claims, DSE, and E&B to resolve member and provider appeals . + Ensures appeals and grievances are… more
- State of Colorado (Grand Junction, CO)
- …to teach them to provide a safe and secure environment and acts as a work lead /supervisor for the team of Clinical Security/Safety Officers. This position is ... CORRECTIONAL, YOUTH, OR CLINICAL SECURITY OFFICER I- Grand Junction Regional Center...including entering into databases and emailing to the safety team + notifies appropriate team members or… more
- Kepro (Asheboro, NC)
- …a vital partner for health solutions in the public sector. Acentra Health seeks a Clinical Assessor to join our growing team . Job Summary: Acentra Health is ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra… more
- LA Care Health Plan (Los Angeles, CA)
- …Develop and maintain Stars work plan, convene committees and workgroups, and assist Stars Lead and Stars Core Team by leveraging technology and tools to ... Clinical Quality Program Manager II (CAHPS) Job Category:...satisfaction for LAC members. Work closely with Stars Core Team (Stars Lead and Manager Stars Analytics)… more
- State of Colorado (Golden, CO)
- Social Worker/Counselor IV (Behavioral Health Lead ) - Summit YSC Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4526385) Apply Social ... Worker/Counselor IV (Behavioral Health Lead ) - Summit YSC Salary $82,572.00 - $115,596.00 Annually...the Position: This position exists to provide behavioral health clinical services to committed and detained youth in the… more
- CommonSpirit Health Mountain Region (Westminster, CO)
- …with resources to help you flourish and leaders who care about your success. Join our team as a Registered Nurse (RN) Clinical Coordinator. In the role of RN ... is one of the nation's largest nonprofit, faith-based health systems, with a team of over 150,000 employees and 25,000 physicians and advanced practice clinicians.… more
- CareFirst (Washington, DC)
- …is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources. **QUALIFICATIONS:** **Education Level:** High ... **Resp & Qualifications** **PURPOSE:** The Sr Clinical Medical Review Nurse handles day to day...review of complex professional and institutional claims and provider appeals that require medical review to determine if the… more
- Trinity Health (Des Moines, IA)
- …Type:** Full time **Shift:** Day Shift **Description:** The purpose of the Clinical Integration Specialist is to assist and support the Director in quality ... for Medicare and Medicaid Services (CMS), Iowa Department of Inspections and Appeals (IDIA), The Joint Commission (TJC),etc.), in conjunction with the hospital's… more