- CommuniCare Family of Companies (Columbus, OH)
- …The Director will accurately report the authorization status of patients and denials and appeals status to the CEO, CFO, and Business Office staff. ... licensed clinician to lead our Utilization Review team. The Utilization Review Director oversees the Utilization Review Department for both Inpatient and Outpatient… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …and to pivot from a "job" opportunity to an authentic experience! The Medical Director of Behavioral Health is responsible for clinical oversight, clinical ... to, case management, quality management, utilization management (UM), and grievance and appeals and committee participation. The Medical Director of Behavioral… more
- Jaz Staffing Agency (Houston, TX)
- …case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals . Uses data to drive decisions and plan/implement ... for specific performance and/or outcome indicators as determined by Director of Outcomes Management. Documents key clinical ...by Director of Outcomes Management. Documents key clinical path variances and outcomes which relate to areas… more
- UofL Health (Louisville, KY)
- …and billing problems, such as appropriate patient status, correct payor source, denials , appeals , and system issues Other Functions: *Develops a cooperative, ... the Utilization Management process including but not limited to: making clinical recommendations regarding medical necessity for admission and continues stay,… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... needed for workflow or identification of trends. Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and… more
- BronxCare Health System (Bronx, NY)
- …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... for the staff on identified deficiencies to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely… more
- Prime Healthcare (Ontario, CA)
- …seeking new members to join our corporate team! Responsibilities The Corporate Director of Clinical Utilization Management (UM) provides comprehensive oversight ... Customer Service, to provide guidance on complex Authorizations, Referrals, Denials and Appeals . + Integrates and coordinates...+ A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large… more
- Brockton Hospital (Brockton, MA)
- …external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the ... PURPOSE OF POSITION: The Director of Case Management is responsible for planning,...the development and supervision of staff (RNs, LPN's,SWs and non- clinical support), evaluation and maintenance of case management skills… more
- HCA Healthcare (Manchester, NH)
- …new medical staff members (in partnership with other key stakeholders to include Director of Advanced Clinical and IT&S personnel). Facilitate orientation for ... We care like family! Jump-start your career as a Director Medical Staff Services today with Catholic Medical Center....play a key role in the integration of HCA Clinical Strategies and HCA systems. **Medical Staff Administration** Develop… more
- Presbyterian Homes and Services (Roseville, MN)
- …space available. Reporting Structure The RAI Director reports directly to the Director of Clinical Services and supervises MDS nurses and coordinates the ... Overview Presbyterian Homes & Services is seeking an RAI Director to join our team. The RAI Director...clinical billing), review ancillary service charges. + Determine denials /communications at IDT, track residents in 30 day window,… more
- Bayer (Boston, MA)
- …and Managed Plans; + Experience in educating and supporting Prior Authorization process, appeals , and denials ; + Covermymeds - portal access experience a plus; ... diverse minds to make a real difference, there's only one choice.** **Associate Director - Field Reimbursement - Oncology - (Northeast USA)** **Associate Director… more
- Hartford HealthCare (Farmington, CT)
- …(HIM) Clinical Documentation Integrity (CDI) quality, audit, education, and denials prevention program consistent with clinical , regulatory, contractual, and ... (HACs), and other specialty reviews. This position also supports denials and appeals specialists as a subject...*_Working Relationship:_* . *This Job Reports To (Job Title):*HHC Director of Clinical Documentation Integrity** . *Job… more
- Mount Sinai Health System (Long Island City, NY)
- …collection, data received from external agencies, Physician 9.Advisors and the Medical Director . 10.Ensures Discharge Appeals functions are carried out within ... **Job Description** The Director will direct and manage departmental activities involved...direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate the case… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director , CC/DP and Utilization Review, provides clinical and management leadership across multiple hospitals within the region. This role ... and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice President of Care...denials . + Direct UM functions, collaborating with CC/DP, clinical teams, and attending physicians to optimize care delivery… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and ... Clinical Authorization Specialist is also responsible for managing denials related to front-end prior authorization, biosimilar drugs, pharmacy-benefit exclusion… more
- Catholic Health Services (West Islip, NY)
- Overview The Director of Care Management is responsible for providing overall management of the Care Coordination department responsible for patient care ... of Care Coordination, Social Workers, and office administrative staff. In addition the director will oversee bed management including the Hub. Job Details The … more
- Children's Mercy Kansas City (Kansas City, MO)
- …lives of children beyond the walls of our hospital. Overview The Director of Care Management responsible for providing leadership, strategic planning, and oversight ... promoting interdisciplinary collaboration, teamwork, and championing service excellence. The Director of Care Management works under the strategic direction of… more
- Growth Ortho (Tampa, FL)
- Job Title: Director of Payer Strategy & Contracting Location: Remote (with limited travel, approx. 2 4 days/month) Reports To: SVP, Revenue Cycle Organization: ... Position Summary: Growth Orthopedics (GO) is seeking a strategic and experienced Director of Payer Strategy & Contracting to lead enterprise-wide initiatives that… more
- Insight Global (Boston, MA)
- …within the Operations organization. This position will fall within the Clinical Performance, Operations, and Innovation organization. The Director is ... benefits, SCO experience is a plus -Understanding of insurance processes such as appeals and processing denials -Experience and understanding of compliance with… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN… more
