- John George Psychiatric Pavilion (San Leandro, CA)
- SUMMARY: Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE : The ... care, continued stay criteria for medical necessity and appropriateness of care, Resource Management issues, other issues including concerns involving under/over… more
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Clinical Appeals Nurse Manager? At Parallon, you come first. HCA Healthcare has ... pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k)...make a difference. We are looking for a dedicated Clinical Appeals Nurse Manager like you to… 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, ... to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN...an environment in which quality flourishes. Serves as a member/ resource /liaison to the A&G Operations Team. Recommends resources… more
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Clinical Appeals Team Lead? At Parallon, you come first. HCA Healthcare has ... pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k)...make a difference. We are looking for a dedicated Clinical Appeals Team Lead like you to… more
- HCA Healthcare (Brentwood, TN)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Appeals Nurse RN you want with your current employer? We have an exciting ... pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k)...of colleagues. Do you want to work as a Clinical Appeals Nurse RN where your passion… more
- Penn Medicine (Philadelphia, PA)
- …corrections, denial activity) necessary to accomplish the goals and objectives of the Clinical Resource Management Department and the organization. + Orders ... Appeals Coordinator in all phases of the Clinical Quality and Utilization Management functions including...payer programs in order to function as a departmental resource . + Performs any additional duties as required to… more
- Kepro (Indianapolis, IN)
- …health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job Summary: ... Our Utilization Management Appeals Nurse - LPN/RN will help...timely and complaint processing. They will be a crucial resource for the Appeals Team, contribute to… more
- Elevance Health (East Syracuse, NY)
- …grievance and appeals data for submission to appropriate parties. + Serves as clinical resource expert and mentor to unit and other departments for complex ... federal health programs. **The Manager II - Grievance & Appeals ** is responsible for management oversight of grievances and appeals departmental units… 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. ... activities/deliverables that week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple strategic clinical projects that… more
- The Mount Sinai Health System (New York, NY)
- …education to Case Managers and other hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management , Managed Care ... **The Nursing Clinical Manager (NCM) for Case Management ...and staff education. The NCM Manager serves as a resource /mentor for Case Managers, Social Workers, and other institutional… more
- Trinity Health (Farmington Hills, MI)
- …manner possible: + Coordinates follow-up activities with Utilization Review/Case Management /Coding/Nurse Liaison to provide required clinical support, as ... location. The scope of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of the Payment Resolution team at an assigned… more
- CVS Health (Phoenix, AZ)
- …Mercy Care lines of business. Required Qualifications -Research incoming electronic disputes/ appeals to identify if appropriate for unit based upon published ... business responsibilities. Identify correct resource and reroute inappropriate work items that do not meet disputes/appeal criteria.-Research Plan Sponsor claim… more
- Centene Corporation (Little Rock, AR)
- …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, ... Purpose:** Supervise the day to day operations of the Appeals and Grievance (A&G) staff and functions within the...the corporation's policies and procedures + Serve as a resource to the team regarding escalated or complex issues,… more
- Universal Health Services (Bonham, TX)
- …TMC Bonham is managed by Texoma Medical Center, subsidiary of UHS. The Appeals Specialist is responsible for appealing all insurance denials and prepare relevant ... regarding trends in denials. Demonstrate the ability to ensure accurate and timely appeals to third party payers in compliance with Managed Care contracts and… more
- Trinity Health (Farmington Hills, MI)
- …manner possible: + Coordinates follow-up activities with Utilization Review/Case Management /Coding/Nurse Liaison to provide required clinical support, as ... of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of a team of...state/federal laws as they relate to contracts and the appeals process. Assists in training Payment Resolution Specialist I… more
- Centene Corporation (Sacramento, CA)
- …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, ... processes, regulations, accreditation standards, and industry best practices related to utilization management + Educates and provides resources for utilization … more
- Catholic Health Services (Melville, NY)
- …on reporting topics. Executes project planning (including planning, organizing, and managing resources ) and all phases of the project management life cycle ... an operations' liaison, collaborating with various entities including payers, clinical , financial and/or operational departments. Duties/Responsibilities: Conducts data analysis… more
- Hartford HealthCare (Wethersfield, CT)
- …and denial information. 4. Provides the Clinical Resource Management Nurse with support for denials, appeals , and physician advisor communication. ... in the current, rapidly changing medical environment. *_Position Summary:_* *_ _* The Clinical Resource Management Associate is an integral part of the Care … more
- Rush University Medical Center (Chicago, IL)
- …less than 0.5) **Shift:** **Shift 1** **Work Schedule:** 8 Hr **Summary:** The Clinical resource coordinator (CRC) applies a collaborative approach in working ... disability, veteran status, and other legally protected characteristics.** **Position** Clinical Resource Coordinator Per Diem **Location** US:IL:Chicago **Req… more
- BrightSpring Health Services (Louisville, KY)
- … management . They will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address identified trends in reasons ... Our Company BrightSpring Health Services Overview Clinical Denials Management and Audit monitors,...compliance, legal, clinical support, local operations, and clinical staff) + Acts as a resource … more