- Northeast Georgia Health System, Inc (Gainesville, GA)
- …case management and interdisciplinary healthcare team in facilitating patient care through the continuum. Monitors department activities to ensure optimum case ... develops core case management standards and programs to facilitate optimal patient care and effective transitions to an alternate level of care . Responsible… more
- Dialysis Clinic, Inc. (Sacramento, CA)
- …top talent interested in supporting our nonprofit mission to prioritize individualized care for patients facing chronic kidney disease. Our mission states "the ... care of the patient is our reason for existence,"...relationships and gain fulfillment serving individuals in our comfortable clinical setting with a lower caregiver-to-patient ratio than other… more
- LA Care Health Plan (Los Angeles, CA)
- …Skills Required: Knowledge of state, federal and regulatory requirements in Appeals / Care /Case/Utilization Management /Quality. Strong verbal and written ... in Nursing Experience Required: Minimum of 8 years of acute/ clinical care experience. Minimum of 2 years...in a lead/supervisory experience. Equivalency: Completion of the LA Care Management Certificate Training Program may substitute… more
- University of Washington (Seattle, WA)
- …**UW MEDICINE'S PATIENT FINANCIAL SERVICES Department** has an outstanding opportunity for a ** CLINICAL APPEALS AND DISPUTES NURSE** **Work Schedule** + 100% FTE ... communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process +...of experience required in one of the following areas: clinical , case management , denials, billing + Familiarity… more
- VNS Health (Manhattan, NY)
- …state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care ... OverviewResolves grievances, appeals and external reviews for one of the...VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. Ensures… more
- R1 RCM (Salt Lake City, UT)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse** , you will help our hospital ... clients by serving as an expert on appeals and denials management where claims were...position. **Here's what you will experience working as a Clinical Appeals Nurse:** + Conduct a detailed… more
- HCA Healthcare (Nashville, TN)
- …our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Appeals Team Lead with Parallon you can be a part of an ... and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +...in our organization. We are looking for an enthusiastic Clinical Appeals Team Lead to help us… more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity...and DRG principles required. + Experience in a health care setting preferred. + Experience in appeals … more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, September 9, 2024 Centers Plan for Healthy Living's goal ... a managed care environment in related area of responsibility, (ie utilization management , quality management , grievances, and appeals ) Type of Experience… more
- Martin's Point Health Care (Portland, ME)
- …as well as other internal and external partners to ensure a comprehensive appeals management process. Job Description Specialist II Key Outcomes: + Serves ... provider pre- and post-service appeals , and participating provider pre-service appeals . The Specialists collaborates with Care Managers, Medical Directors… more
- Commonwealth Care Alliance (Boston, MA)
- …is compliant and meeting all strict deadlines. - When necessary collaborate with care teams, clinical staff, family members, and other involved in providing ... **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department...This position works collaboratively across many departments at Commonwealth Care Alliance (CCA) as well as externally to facilitate… more
- Commonwealth Care Alliance (Boston, MA)
- …This Role is Important to Us:** **Position Summary:** Reporting to the Director of Appeals & Grievances, the Manager, Appeals & Grievances (A&G) Audit and ... Oversight is responsible for the oversight of Plan level appeals and grievances within the Appeals &...professional work relationships, working collaboratively with all levels of management and business owners to help guide the discipline… more
- VNS Health (Manhattan, NY)
- …opportunities What You Will Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & ... and prepares data reports and analysis of grievance and appeals for program management and committees, as...and Medicaid appeal and grievance processes, incidents, quality of care concerns and any other inquires requiring clinical… more
- LA Care Health Plan (Los Angeles, CA)
- …Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... with health care access or benefit coordination issues, ensuring that clinical grievances, complaints and complex issues are investigated and resolved to the… more
- Banner Health (AZ)
- **Primary City/State:** Arizona, Arizona **Department Name:** Grievances & Appeals **Work Shift:** Day **Job Category:** General Operations Great careers are built ... by including remote and hybrid opportunities. In the role of Senior Grievance & Appeals Coordinator, you will utilize your expertise in Grievance & Appeals and… more
- CVS Health (Lansing, MI)
- … system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. **This is a ... appeals to the appeal nurses and territory Utilization Management Staff * Participate in ongoing initiatives to improve...(2) or more years of experience in a Health Care Delivery System eg, Clinical Practice or… more
- Elevance Health (Los Angeles, CA)
- … and non clinical services, quality of service, and quality of care issues to include executive and regulatory grievances. **How you will make an impact:** ... management review activities which require the interpretation of clinical information. + The analyst may serve as a...analyst may serve as a liaison between grievances & appeals and /or medical management , legal, and/or… more
- Elevance Health (Richmond, VA)
- … and non clinical services, quality of service, and quality of care issues to include executive and regulatory grievances. **How you will make an impact:** ... analyst may serve as a liaison between grievances & appeals and /or medical management , legal, and/or...management review activities which require the interpretation of clinical information. + Identify opportunities for improvement and any… more
- Elevance Health (Columbus, OH)
- …Virginia, Indiana, Kentucky or New York. The **Manager I - Grievances & Appeals ** is responsible for the management oversight of receipt, investigation and ... clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and...clinical services, quality of service and quality of care issues including executive and regulatory grievances. + May… more
- Carle (Urbana, IL)
- …resource in outpatient clinical documentation review to establish and manage clinical and prior authorization denial appeals for the Carle enterprise. ... Represents Carle in clinical meetings and writing appeals on outpatient accounts where medical necessity, level of...hire. EXPERIENCE REQUIREMENTS Three years of experience in health care with focus in reimbursement and/or case management… more
