- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …Direct and support physician review to ensure timeliness, accuracy and reliability of UM and Appeals reviews\. + Lead and serve on various committees in order to ... Provides clinical leadership and serves as an internal medical...work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability\. + Outstanding… more
- Liberty Healthcare Corporation (Nashville, TN)
- …seeks to hire a licensed behavioral professional for an anticipated new PASSR Program Lead position. This is a key role with a statewide program which will help ... Medical or Level of Care (LOC) eligibility assessment and appeals for Long-Term Services and Supports (LTSS) + Supports...people in their residences. As Liberty Healthcare's PASRR Program Lead , you will enjoy a wide array of responsibilities,… more
- Humana (Nashville, TN)
- …resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and ... and consumer direction. + Actively participates in interdisciplinary care team and provides clinical physician support for...region, aiding in case review, peer to peer and appeals as needed. + Provide weekend and holiday Medical… more
- HCA Healthcare (Hendersonville, TN)
- …optimum patient experience. **What you will do in this role:** + You will lead clinical performance expectations that support the goals of consistent clinical ... consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials process, discharge planning, case… more
- Humana (Nashville, TN)
- …resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
- Humana (Nashville, TN)
- …resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal… more
- Humana (Nashville, TN)
- …and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, ... reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services.… more