- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you want to join an organization that invests in you as a Clinical Appeals Team Lead ? At Parallon, you come first. ... and you have the opportunity to make a difference. We are looking for a dedicated Clinical Appeals Team Lead like you to be a part of our team . **Job… more
- 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
- Elevance Health (Cincinnati, OH)
- …**Grievance/ Appeals Analyst Lead ** is responsible for leading and coaching a team of Grievance & Appeals Analysts in the Enterprise Grievance & ... **Grievance/ Appeals Analyst Lead ** **Must be located...and process pre service and post service grievances and appeals requests related to clinical and non… 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
- 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
- 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
- Centene Corporation (Phoenix, 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)
- …(PBS) location. The scope of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of a team of payment resolution ... knowledge of state/federal laws as they relate to contracts and the appeals process. Assists in training Payment Resolution Specialist I colleagues upon hire… more
- Trinity Health (Farmington Hills, MI)
- …Manages and oversees day-to-day activities and responsibilities of the payment resolution/denials team handling the receipt, analysis, and appeals of denials ... PURPOSE** Work Remote Position (Pay Range: $39.8218-$59.7327) Manages and oversees a team responsible for all post billed denials (inclusive of clinical … 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
- Veterans Affairs, Veterans Health Administration (Loma Linda, CA)
- Summary VA Loma Linda Health Care System (VALLHCS) is recruiting for a Lead Health Technician (Telehealth Clinical ) to provide an array of complex and ... virtual position. Functional Statement #: 000000 Position Description Title/PD#: Lead Health Technician (Telehealth Clinical )/PD000000 Relocation/Recruitment Incentives:… more
- State of Colorado (Golden, CO)
- …of each fiscal year. Plans for and directs the professional development of the Clinical team , trains to relevant standards of policy and procedure, resolves ... population within the Department of Human Services, Division of Youth Services. Afford clinical expertise and feedback to mental health team members regarding… more
- State of Colorado (Pueblo, CO)
- CORRECTIONAL, YOUTH, OR CLINICAL SECURITY OFFICER I - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4514229) Apply CORRECTIONAL, ... YOUTH, OR CLINICAL SECURITY OFFICER I - Pueblo Salary $2,104.62 Biweekly...promotes accountability to victims and communities, and helps youth lead constructive lives through positive youth development. The strategic… more
- Kepro (Gastonia, 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 (Denver, CO)
- …with other clinics requesting consultation and/or assistance with coverage. Serves as the lead medical liaison with the mental health team . Supervises and trains ... Lead Mid Level Provider - Gilliam Youth Services...primary oversight and supervision of the clinic. Job Duties: Clinical Management: Functions as the facility medical authority (RHA).… more