- R1 RCM (Detroit, MI)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... remote, production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical… more
- R1 RCM (Detroit, MI)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... remote production-drive position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to… more
- McLaren Health Care (Detroit, MI)
- …(inpatient vs. outpatient) based on medical necessity. Actively seeks additional clinical documentation from the physician to optimize hospital reimbursement when ... payer requirement. 5. Documents in the electronic medical record (EMR): clinical reviews (medical necessity), payer authorizations, avoidable days, readmission risk… more
- Molina Healthcare (Detroit, MI)
- …state, and local laws and regulatory requirements affecting the medical and clinical staff. Must reside in Michigan** **Job Duties** + Provides medical oversight ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- Elevance Health (Dearborn, MI)
- ** Clinical Operations Medical Director** **Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management** **$20,000 Sign On Bonus** ... Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology._ The ** Clinical … more
- Corewell Health (Royal Oak, MI)
- …criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization ... adult and Level II pediatric trauma designations. The advanced capabilities and clinical expertise within this center have earned it Magnet designation four… more
- Corewell Health (Trenton, MI)
- …criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization ... Health Advantage Award in the category of Health and Clinical Outcomes. It is home to nine university affiliated...review, home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan License Upon Hire… more