- Centene Corporation (Salem, OR)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. + Maintain files and logs for all appeals +… more
- Catholic Health Services (Melville, NY)
- …Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate utilization ... management and appeals functions to include coordination of specific process and...+ Ability to utilize critical thinking and apply sound clinical judgment and assessment skills for decision-making. + Knowledge… more
- CVS Health (CA)
- …PST Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more
- Centene Corporation (Salem, OR)
- …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, ... Time (PST). (PST) residents strongly preferred **2+ years grievance or appeals , claims, managed care, or relevant experience.** **Position Purpose:** Analyze and… more
- CVS Health (Harrisburg, PA)
- …issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from ... outside plan sponsors or regulators. * Research and resolves incoming electronic appeals as appropriate as a "single-point-of-contact" based on type of appeal. *… more
- Nuvance Health (Danbury, CT)
- …5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician ... and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in… more
- University of Michigan (Ann Arbor, MI)
- Clinical Denials Prevention & Appeals Specialist Apply Now **Job Summary** The Clinical Denials Prevention & Appeals Specialist role is entirely remote. ... The Clinical Denials Prevention & Appeals Specialist plays a critical role in optimizing the...their meticulous work + Collaborate with leadership and CDI Coordinator to conduct new-hire training and orientation. **Required Qualifications… more
- CommonSpirit Health (Englewood, CO)
- …We are seeking a highly skilled individual to develop and submit clinical appeals , expertly crafting physician-aligned letters based on federal and ... regulations, including CMS rules and the Two-Midnight Rule, while leveraging clinical criteria and prioritizing medical necessity to defend inpatient status. This… more
- Select Medical (Dallas, TX)
- …joint venture with Select Medical & Baylor Scott & White Health Dallas, TX ** Clinical Intake Coordinator / Clinical Liaison (RN strongly preferred)** ... Disabled/Veterans_ Apply for this job (https://jobs-selectmedicalcorp.icims.com/jobs/342545/ clinical -intake- coordinator neurotransitional-center-%28-rn-strongly-preferred-%29/job?mode=apply&apply=yes&in\_iframe=1&hashed=1374627814) Share… more
- Touro University (Hawthorne, NY)
- Overview A professional and productive clinical educational coordinator (CEC) plays a significant role in the day-to-day administration of a successful medical ... also a central point of contact for faculty and administrators from affiliated clinical sites where students are assigned to clerkship and elective rotations. This… more
- Providence (OR)
- …the best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care ... + Oregon **Required qualifications for this position include:** + 5+ years clinical nursing experience + Experience working with physicians in the collaboration and… more
- University of Colorado (Denver, CO)
- **Global Education Coordinator ** **University of Colorado Denver** Global Education Coordinator -37821 University Staff **Description** **Position Details** ... **Official Title: Academic Services Intermediate Professional** **Working Title: Global Education Coordinator ** **FTE: Full Time 1.0 (100%) FTE | Hybrid** **Salary… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Denial Coordinator is responsible for reviewing, tracking, and resolving denied claims, ensuring that appropriate appeals are submitted, and ... and ensure compliance with payer guidelines. As a Denial Coordinator at Community Health Systems (CHS) - SSC Nashville,...other host systems, ensuring timely follow-up on denials and appeals . + Conducts follow-up calls and payer portal research… more
- Genesis Healthcare (PA)
- …plans to Full-Time and Part-Time team members. + **Support for New Grads & Clinical Fellows:** Our Powerback Clinical Mentorship Program kicks off on day one, ... Clinicians in Action professional development program. Responsibilities The Reimbursement Coordinator assists the Powerback denial management team gathering records… more
- Elderwood (Waverly, NY)
- …handles Third Party appeals , peer to peers as applicable and with clinical oversight provided by the LPN/RN MDS Coordinator . Attends team meetings at ... Salary $ 20 / $ 22 Overview Managed Care Coordinator Overview Mon-Fri 8am-4pm The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator … more
- State of Colorado (Pueblo, CO)
- Nurse I - ECT & Outpatient Coordinator - CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5094633) Apply Nurse I - ECT & Outpatient ... Coordinator - CMHHIP Salary $43.80 - $61.31 Hourly Location...the Position: This position maintains a generalist set of clinical skills for a wide variety of medical procedures,… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Denial Coordinator is responsible for reviewing, tracking, and resolving denied claims, ensuring that appropriate appeals are submitted, and ... Hyland, BARRT, and other host systems, ensuring timely follow-up on denials and appeals . + Conducts follow-up calls and payer portal research to track the status… more
- HCA Healthcare (Manchester, NH)
- …care like family! Jump-start your career as a Medical Staff Services Coordinator today with Catholic Medical Center. **Benefits** Catholic Medical Center, offers a ... Come join our team as a Medical Staff Services Coordinator . We care for our community! Just last year,...play a key role in the integration of HCA Clinical Strategies and HCA systems. 1. Medical Staff Administration… more
- State of Colorado (Grand Junction, CO)
- Community Integration Coordinator (HEALTH PRO II) - Grand Junction Regional Center **Western Slope** Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5099365) Apply Community Integration Coordinator (HEALTH PRO II) - Grand Junction Regional Center… more
- Elderwood (Cheektowaga, NY)
- …and reimbursement methodology? We want to talk with you! RN - MDS Coordinator Position Overview: + Oversees, reviews and/or completes the MDS/PPS components of the ... individual assessment. + Acts as support/liaison to the business office coordinator and/or designee in determining eligibility for Medicare and tracking Medicare… more