- Trinity Health (Columbus, OH)
- …financial analysis, audit, provider relations and more. **Position Purpose:** The Appeals and Grievance Coordinator is responsible for the processing and ... Responsible for preparation of case files and review with clinical colleagues. + Screen all incoming grievances, appeals... clinical colleagues. + Screen all incoming grievances, appeals and provider claim dispute to ensure they are… more
- Centene Corporation (Bedford, NH)
- …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
- WMCHealth (Valhalla, NY)
- Asst Utilization Coordinator - Appeals Company: Westchester Medical Center City/State: Valhalla, NY Category: Nursing/Nursing Management Department: Clinical ... link Job Details: Internal Posting: 02/25/25 to 03/10/25 Assistant Utilization Coordinator Summary: Under general supervision, an incumbent of this class assists… more
- CVS Health (Hartford, CT)
- …more compassionate. And we do it all with heart, each and every day. **Medicare Clinical Appeals Analyst Position Summary** The Clinical Appeals Analyst ... supporting day-to-day operations for the par provider Medicare Advantage plan appeals department. This is a fast-paced department that requires working independently… 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
- 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 Exemption Status Exempt Department Pharmacy Manager Title ... 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
- Fallon Health (Worcester, MA)
- …NCQA standards, other applicable regulatory requirements and member expectations. The FH Member Appeals & Grievances Coordinator serves to administer the FH ... of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Coordinator serves as a liaison between FH… more
- CommonSpirit Health Mountain Region (Westminster, CO)
- …leaders who genuinely care about your growth and achievements. As an RN Clinical Coordinator you will actively support the department director/manager by ... care for orthopedic, abdominal, and general surgeries. 5 West appeals to anyone interested in broadening their skillset as...coordinating clinical and department activities for the unit. You will… 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 (Waverly, 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 $ 20 / $ 22 Overview Managed Care Coordinator Overview Mon-Fri 8am-4pm The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator … 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 (Denver, CO)
- Health Professional V- FCBS CR Coordinator /Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4964150) Apply Health Professional V- ... FCBS CR Coordinator /Supervisor Salary $78,684.00 - $110,160.00 Annually Location Denver, CO Job Type Full Time Job Number IIB 03507 6/6/25 Department Colorado… more
- Centene Corporation (Tacoma, WA)
- …with customer expectations and lead clinical quality initiatives. Review clinical information for appeals to determine medical necessity of services, ... + Lead Behavioral Health Performance Improvement Projects (PIPS) + Review clinical information for appeals to determine medical necessity + Prepare cases for … more
- Centene Corporation (Baton Rouge, LA)
- …with customer expectations and lead clinical quality initiatives. Review clinical information for appeals to determine medical necessity of services, ... + Lead Behavioral Health Performance Improvement Projects (PIPS) + Review clinical information for appeals to determine medical necessity + Prepare cases for … more
- BayCare Health System (Tampa, FL)
- …that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence. **Are you a passionate and dedicated Nurse Care Coordinator ... others?** We are looking for an experienced and proactive **RN / Care Coordinator ** to join our care team. This vital role blends patient-facing responsibilities… more
- Elderwood (Waverly, NY)
- …and reimbursement methodology? We want to talk with you! RN - MDS Coordinator Position Overview: + Oversees, reviews and/or completes the MDS/PPS components of the ... 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
- Sacramento County (Sacramento, CA)
- Treatment Center Program Coordinator Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1180508) Apply Treatment Center Program Coordinator ... management with emphasis on health occupations + Principles and techniques of clinical interviewing, diagnosis, and treatment + Most current version of the Diagnosis… more