- Pyramid Consulting, Inc. (Fort Myers, FL)
- Immediate need for a talented Long term care coordinator . This is a 03+ months contract opportunity with long-term potential and is located in Florida(Hybrid). ... long-term care services! Assist member with filing and resolving complaints and appeals . Key Requirements and Technology Experience: Key skills; Care management Long… more
- Community Medical Services (South Milwaukee, WI)
- …OBHL, RHBA, state, DEA, fire, and alarm). Work alongside assigned Clinical Coordinator to assist with grievances, appeals , and complaints from clients and ... staffing standards for clinics based on patient care needs, workflow, and other clinical needs. Identify, de-escalate, and solve patient concerns as they arise Work… more
- Centene Corporation (Olympia, WA)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. + Maintain files and logs for all appeals +… more
- Centene Corporation (Salem, OR)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. + Maintain files and logs for all appeals +… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center … more
- Munson Healthcare (Traverse City, MI)
- …and initiating the authorization process. 10. Identifies and facilitates appeal responses, gathers clinical packets for appeals , and follows up on appeals ... experience in a revenue cycle role (billing, registration, insurance verification, referral coordinator , etc) . Ability to work independently and problem solve with… more
- Centene Corporation (Phoenix, AZ)
- …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, ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- Centene Corporation (Phoenix, AZ)
- …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, ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- Commonwealth Care Alliance (Boston, MA)
- …, operations, pharmacy, dental, reporting, and member services. + Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day ... 011540 CCA- Appeals & Grievances **Position Summary** Appeals ...strict deadlines. + When necessary collaborate with care teams, clinical staff, family members, and other involved in providing… more
- Robert Half Accountemps (Los Angeles, CA)
- …guidelines for use by examiners or Participant Services Representatives. * Assist Appeals Coordinator with the preparation of Benefits Committee appeal cases. ... IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist. The Grievance & Appeals Specialist, will be in responsible for… more
- Squirrel Hill Health Center (Pittsburgh, PA)
- …Health Center (SHHC), is a Federally Qualified Health Center (FQHC), seeking a dedicated Clinical Support Coordinator to join our team. The ideal candidate will ... and insurance companies to streamline the authorization process. The Clinical Support Coordinator will assist SHHC Providers...of approval or denial statuses, including next steps for appeals if necessary. + Documentation: + Accurately… more
- CareOregon (Portland, OR)
- …Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Pharmacy Clinical Coordinator - (Prior Authorization) - Contingent Exemption Status Exempt ... use reviews. + Review medication prior authorization requests and appeals . + Develop and implement clinical educational...requests and appeals . + Develop and implement clinical educational programs to improve drug utilization and quality.… more
- Trinity Health (Hartford, CT)
- …Type:** Full time **Shift:** Day Shift **Description:** **Position Purpose** The Clinical Pre-Service Nurse Coordinator is directly responsible for reviewing ... trends to remediate issues and assist with internal process improvement. Leverages clinical knowledge and standard procedures to ensure timely attention to denials… more
- CVS Health (Oklahoma City, OK)
- …day. **Position Summary** Responsible for intake, investigation and resolution of appeals , complaints and grievances scenarios for all products, which may contain ... responses from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance. Identify trends and emerging issues and report… more
- Elderwood (Cheektowaga, NY)
- …handles Third Party appeals , peer to peers as applicable and with clinical oversight provided by the LPN/RN MDS Coordinator . Attends team meetings at ... Salary $18.50 - $23.07/Hour Overview Managed Care Coordinator Overview The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator with case… more
- HCA Healthcare (Manchester, NH)
- …care like family! Jump-start your career as a Medical Staff Services Coordinator today with Catholic Medical Center. **Benefits** Catholic Medical Center, offers a ... Come join our team as a Medical Staff Services Coordinator . We care for our community! Just last year,...play a key role in the integration of HCA Clinical Strategies and HCA systems. 1. Medical Staff Administration… more
- State of Colorado (Grand Junction, CO)
- Community Integration Coordinator (HEALTH PRO II) - Grand Junction Regional Center **Western Slope** Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4974492) Apply Community Integration Coordinator (HEALTH PRO II) - Grand Junction Regional Center… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Case Management (CM) Coordinator position is a proficient CM representative that provides technical, clerical and data management support ... and other community resources and transportation. In addition, the CM Coordinator position anticipates independent actions necessary to provide competent and… more
- Elderwood (Liverpool, NY)
- …methodology? Elderwood at Liverpool wants to talk with you! RN - MDS Coordinator Position Overview: + Oversees, reviews and/or completes the MDS/PPS components of ... individual assessment. + Acts as support/liaison to the business office coordinator and/or designee in determining eligibility for Medicare and tracking Medicare… more
- Guthrie (Sayre, PA)
- …well as identifies, analyzes and takes the necessary action to submit complex appeals to insurance payers. Reviews all medical chart and account documentation in ... to determine appropriate coding and initiate corrected claims and appeals . Interprets payer guidelines, regulatory guidelines, contractual obligations and works… more
