- 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
- Community Health Systems (Franklin, TN)
- …reduce future denials, and ensure compliance with payer guidelines. As a Denial Appeals Coordinator at Community Health Systems (CHS) - PCCM, you'll play ... **Job Summary** The Denial Coordinator is responsible for reviewing, tracking, and resolving...reviewing, tracking, and resolving denied claims, ensuring that appropriate appeals are submitted, and working closely with payers, internal… more
- CVS Health (Sacramento, CA)
- …issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from ... contact with outside plan sponsors or regulators. Research and resolves Fast Track Appeals as appropriate. Can identify and reroute inappropriate work items that do… more
- CVS Health (Boise, ID)
- …issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from ... outside plan sponsors or regulators. + Research and resolves incoming electronic appeals as appropriate as a "single-point-of-contact" based on type of appeal. +… more
- Nuvance Health (Danbury, CT)
- …5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician ... and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in… more
- Providence (Beaverton, OR)
- …the best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care ... + Oregon **Required qualifications for this position include:** + 5+ years clinical nursing experience + Experience working with physicians in the collaboration and… more
- Elderwood (Amherst, 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 Pay: $18.50 - $23.07 / Hour Overview Managed Care Coordinator Overview The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator … more
- Genesis Healthcare (FL)
- …plans to Full-Time and Part-Time team members. + **Support for New Grads & Clinical Fellows:** Our Powerback Clinical Mentorship Program kicks off on day one, ... Clinicians in Action professional development program. Responsibilities The Reimbursement Coordinator assists the Powerback denial management team gathering records… 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
- Community Health Systems (Antioch, TN)
- **Job Summary** The Denial Coordinator is responsible for reviewing, tracking, and resolving denied claims, ensuring that appropriate appeals are submitted, and ... Hyland, BARRT, and other host systems, ensuring timely follow-up on denials and appeals . + Conducts follow-up calls and payer portal research to track the status… more
- Sharp HealthCare (San Diego, CA)
- …and employer business practices. **What You Will Do** The Transplant Financial Coordinator plays an integral role in assisting patients with the critical function ... billing compliance. The primary responsibility of the Transplant Financial Coordinator is assessing patient's insurance coverage and financial situation for… more
- Cedars-Sinai (Beverly Hills, CA)
- …innovation. **A Little More About What You Will be Doing** The RN Care Coordinator is responsible for the case management of patient while hospitalized and upon ... In collaboration with the Inpatient Specialty Program (ISP) hospitalists, the RN Care Coordinator will assist patients from the time they are admitted until they are… more
- AdventHealth (Tampa, FL)
- …Research Institute, also located at AdventHealth Tampa, leads the way in clinical and academic research in the areas of neuroscience, cardiovascular medicine, ... **The ro** **le you'll contribute:** The Ambulatory Payment Classification (APC) Coordinator is responsible for assigning, monitoring, and evaluating the assignment… more
- Sacramento County (Sacramento, CA)
- Treatment Center Program Coordinator *Revised Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1180508) Apply Treatment Center Program ... Coordinator *Revised Salary $114,401.52 - $139,060.80 Annually Location Sacramento,...emphasis on health occupations + Principles and techniques of clinical interviewing, diagnosis, and treatment + Most current version… more
- Elevance Health (Vinton, IA)
- **LTSS Service Coordinator ** _Location:_ Candidate would need to meet face to face with patients in and around the following counties. Candidate will be assigned a ... an accommodation is granted as required by law._ The **LTSS Service Coordinator ** is responsible for conducting service coordination functions for a defined caseload… more
- Elevance Health (Steubenville, OH)
- **LTSS Service Coordinator (Case Manager)** **Hiring near Cadiz, Coshocton, Gallipolis, Jackson, Millersburg, New Philadelphia, Portsmouth, Steubenville** ... long term services and supports, and psychosocial needs. The **LTSS Service Coordinator ** is responsible for managing service coordination for a designated caseload… more
- Elevance Health (Neillsville, WI)
- **LTSS Service Coordinator (Case Manager)** **Hiring near Southwestern Wisconsin in counties:** Pepin, Buffalo, Trempealeau, Jackson, Clark, La Crosse, Monroe, ... living, employment, and contributing to their communities. The **LTSS Service Coordinator ** is responsible for conducting service coordination functions for a… more
- US Tech Solutions (RI)
- …with other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). + Identify and elevate clinical inquiries to the ... + Maintains complete, timely and accurate documentation of reviews. + Transfers all clinical questions, escalations and judgement calls to the pharmacist team. + The… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non- clinical tasks related to processing ... Utilization Management prior authorization sand appeals . JOB RESPONSIBILITIES + Monitor incoming faxes + Enter...expected timelines EXPERIENCE: + 1 year as a UM Coordinator in a managed care payer environment preferred +… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals ... activities. This role collaborates with payers, hospital staff, and clinical specialists to secure timely authorizations for hospital admissions and extended stays.… more