- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... **SUMMARY:** Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE:… more
- Option Care Health (Omaha, NE)
- …hiring, developing, and retaining a diverse workforce. **Job Description Summary:** The Clinical Transition Specialist is an experienced sales professional who ... patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the… more
- AdventHealth (Tavares, FL)
- … ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The Social Work Specialist is under the ... information and educates interdisciplinary team and patients/caregivers regarding payor requirements/barriers. . Maintains clinical competency and current… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Utilization Management Specialist Full time, 80 hours per pay period, Day shift Covenant Health Overview: Covenant Health is the region's top-performing ... Forbes "Best Employer" seven times. Position Summary: The Utilization Management Specialist I will perform utilization management functions to include medical… more
- Tufts Medicine (Boston, MA)
- …care for an assigned patient population by unit, across the continuum of care. The Case Manager works to achieve daily clinical , quality and cost outcomes by ... continued stay and information needed for discharge. 12. Responds to third party payor requests for concurrent clinical information in timely manner. 13. Ensures… more
- TEKsystems (Plano, TX)
- …issues on accounts. Including but, not limited to Managed Care, Reimbursement, Clinical , Admissions, Facility Business Office Manager, Coding, Case Management, ... for A/R, and mail follow-up on amounts due from Payor 's, and third-party's on a timely basis in accordance...is not a patient collections position) * Respond to payor 's by phone, or correspondence concerning underpaid, or non-paid… more
- Universal Health Services (Auburn Hills, MI)
- …Havenwyck Hospital is seeking a dynamic and talented Quality Improvement Specialist to join our team of compassionate, dedicated professionals. The Lead ... Utilization Management (UM) Case Manager has responsibility for conducting admission and continued...procedures for UM departmental activities and processes. + Through clinical skills (experience and knowledge), reports to external insurance… more
- Universal Health Services (Groton, CT)
- …care internally or transitions to other internal programs. + Collaborate with clinicians/ case managers to obtain pertinent clinical and discharge information. + ... or written appeals when necessary. + Liaison between insurance and clinical staff, providing information to clinicians/ case managers regarding dispositions… more
- Henry Ford Health System (Troy, MI)
- …visits and outpatient procedures. The purpose of the Central Authorization Specialist position is to centrally facilitate the successful procuring of insurance ... providing timely and accurate information to payors'. The Central Authorization Specialist helps drive change by identifying areas where performance improvement is… more
- AdventHealth (Louisville, CO)
- …and other duties as required. Maintains a close working relationship with clinical partners to ensure continual open communication between clinical , ancillary ... bring to the team:** + Accountable for maintaining a working relationship with clinical partners to ensure open communications between clinical , ancillary, and… more
- UCHealth (Loveland, CO)
- Description Patient Access Specialist Sr position with UCHealth Medical Group in primary care and specialty care clinics in Loveland. Full-time positions, several ... and performs related clerical functions. Work collaboratively with the front desk and clinical teams to support patient care in the department's phone room. Work… more
- Tufts Medicine (Lawrence, MA)
- …and financial-clearance duties necessary to facilitate the procurement of clinical services by patients. Collects patient's necessary demographic and financial ... or a role that focuses on support of daily business activities (eg, technical, clinical , non- clinical ) operating in a "hands on" environment. The majority of… more
- Bassett Healthcare (Cooperstown, NY)
- …knowledge and skills necessary to provide care appropriate to each patient. Clinical and Technical Responsibilities: Provides case management services as ... patient to receive IM letter; collaborates with UM Nurse as needed. Assists Clinical Documentation Specialist in engaging physician to respond to queries… more
- AdventHealth (Denver, CO)
- …orders as well as expiring medication orders. Accountable for obtaining clinical information and treatment protocol information from the patient's medical record, ... verifying if treatment is ongoing, new, or altered. After gathering clinical information, responsible for obtaining prior authorization for infusion and injectable… more
- Vanderbilt University Medical Center (Nashville, TN)
- …nature. Possesses sufficient knowledge, training, and experience to independently complete clinical review to obtain payor authorization. Demonstrates mastery in ... * Participates as an active partner with multidisciplinary team members to ensure case is in the appropriate level of care setting. * The responsibilities listed… more
- AdventHealth (Celebration, FL)
- …performs other duties as required. Maintains a close working relationship with clinical partners to ensure continual open communication between clinical , ... and/or units of medication + Maintain close working relationship with clinical partners and physician offices to resolve issues with obtaining pre-authorizations.… more
- Bassett Healthcare (Cooperstown, NY)
- …patient to receive IM letter; collaborates with UM Nurse as needed. Assists Clinical Documentation Specialist in engaging physician to respond to queries ... Worker (LMSW) will work Per Diem, Various Shifts and Weekends and provides case management services as appropriate throughout the life span and in various settings.… more
- Sutter Health (Sacramento, CA)
- **Organization:** SMCS-Valley Administration **Position Overview:** Reviews confidential clinical information and provides personalized referrals to individuals or ... specialty services from a contracted medical group, hospital, or third-party payor . Facilitates referrals to appropriate Sutter facility, program or affiliated and… more
- University of Colorado (Denver, CO)
- …Health Provider / Instructor Series (Open Rank) in the Non-Tenure Clinical Practice Track** **University of Colorado Denver** **Description** **University of ... / Instructor / Senior Instructor (Open Rank) in the Non-Tenure Clinical Practice Track** **Position Location: Sheridan Health Services (Southwest Denver)** **3525… more
- AdventHealth (Shawnee, KS)
- … information and educates interdisciplinary team and patients/caregivers regarding payor requirements/barriers. + Maintains clinical competency and current ... **Inpatient Social Worker Case Manager Weekend Worker Program Days - AdventHealth...efficient and cost-effective care through appropriate resources monitoring and clinical care escalations. The Social Worker is under the… more