- CVS Health (Baton Rouge, LA)
- …solutions. In particular responsible for the review and resolution of clinical documentation, clinical complaints and appeals . Reviews documentation and ... benefit plan structure and regulatory requirements are required to support the appeals review . -Pro-actively and consistently applies the regulatory and… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: LVN/LPT $35.00-44.19 Per Hour ... and optimize reimbursement for external reviewers/third party payers. The Utilization Review Clinician maintains knowledge of, participates in further training… more
- University of Southern California (Los Angeles, CA)
- …a group of senior faculty clinicians; hold weekly small group meetings; provide clinical consultation; review and approve time off and continuing education ... are strongly committed to providing excellent multiculturally and trauma-informed clinical treatment, training, advocacy, prevention, and outreach services. We are… more
- State of Colorado (Crowley County, CO)
- CDOC Mental Health Clinician (Social Worker/Counselor III) - (ARKANSAS VALLEY) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5180103) Apply ... CDOC Mental Health Clinician (Social Worker/Counselor III) - (ARKANSAS VALLEY) Salary $6,885.00...for inmates experiencing acute mental health crisis. + Renders clinical direction to non- clinical staff in mental… more
- City and County of San Francisco (San Francisco, CA)
- …and + May perform Quality Improvement activities such as chart audit and compliance review . + The 2932 Senior Behavioral Health Clinician performs related duties ... Francisco continuously accepts applications for all permanent Senior Behavioral Health Clinician 2932 positions. Rather than publishing separate job ads for every… more
- City and County of San Francisco (San Francisco, CA)
- …of San Francisco continuously accepts applications for all permanent Behavioral Health Clinician 2930 positions. Rather than publishing separate job ads for every ... Homelessness and Supportive Housing and the Department of Public Health can then review your application and contact you directly with details about their positions.… more
- Molina Healthcare (Orem, UT)
- …(Team will work on set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical … more
- US Tech Solutions (May, OK)
- …Pharmacist/ Clinician is an operation-based role that conducts criteria based & clinical review of medical data collected to perform prior authorization as ... per policy and procedure. + The Pharmacist/ Clinician will apply clinical knowledge to plan...urgent PA request as needed. **Responsibilities:** + Evaluate and review all prior authorization requests and render coverage determinations… more
- Whitney Young Health Center (Albany, NY)
- …to continually assess and improve the quality of patient services-conducts monthly utilization review . + Participates in the recruitment of clinical staff. + ... Clinical Supervisor - Substance Use Disorder Programs (LCSW/LMSW/LMHC)...patient access to care, enhance program census, and achieve clinician productivity standards. + Leads and engages clinicians in… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas ... anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in...clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care… more
- UPMC (Pittsburgh, PA)
- …and stakeholders to develop and execute on our population health strategy, clinical and provider operations, and State contract and CMS requirements for the ... the Quadruple Aim of better health, better care, lower costs, and higher clinician satisfaction. The role is primarily working with health plan Medicare (including… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …needs across the continuum of care by leveraging member partnership, pre-service clinical utilization review , case and disease management processes, skill sets ... a critical component of BCBSMN Medical Management team as the primary clinician providing condition and case management services to members. Your Responsibilities *… more
- Cardinal Health (Sacramento, CA)
- …+ Take any action necessary for any denials received by the payor to inform the clinician of changes that may need to happen to not delay patient care. + Complete ... any pre-service appeals to obtain paying approval based on medical necessity....Communicate effectively with all Revenue Cycle Management staff and clinical staff to ensure appropriate treatment can be provided,… more