- Centene Corporation (Jefferson City, MO)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by… more
- Centene Corporation (Trenton, NJ)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... within the Eastern Standard Time Zone.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- CommonSpirit Health (Englewood, CO)
- …We are seeking a highly skilled individual to develop and submit clinical appeals , expertly crafting physician-aligned letters based on federal and ... regulations, including CMS rules and the Two-Midnight Rule, while leveraging clinical criteria and prioritizing medical necessity to defend inpatient status. This… more
- CVS Health (Phoenix, AZ)
- …clinical judgment and regulatory knowledge. **Key Responsibilities** + Responsible for the review and resolution of clinical appeals . + Reviews ... of residence. + 3+ years clinical experience. **Preferred Qualifications** + Appeals , Managed Care, or Utilization Review experience. + Proficiency with… 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 $31.50-37.50 Per Hour ... and optimize reimbursement for external reviewers/third party payers. The Utilization Review Clinician maintains knowledge of, participates in further training… 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/5107717) 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
- Molina Healthcare (Cleveland, OH)
- …(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
- 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
- State of Colorado (Denver, CO)
- Mental Health Clinician II (Staffing Department Rover)-Colorado Mental Health Hospital at Fort Logan Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5115506) Apply Mental Health Clinician II (Staffing Department Rover)-Colorado Mental Health Hospital at… 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
- State of Colorado (Pueblo, CO)
- Social Worker/Counselor III - Clinical Work Lead Continuity of Treatment Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5097088) Apply Social ... Worker/Counselor III - Clinical Work Lead Continuity of Treatment Salary $82,620.00 -...Lastly, this position works with Unit Management Teams to review Unit Schedule and group needs to suggest appropriate… 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
- State of Colorado (Denver, CO)
- …used to fill future vacancies at this location. Description of Job Mental Health Clinician : This position exists to provide clinical mental health skills as the ... mental health consultant and clinician in a designated parole region. This position is...Work Licensure Compact as a Licensed Professional Counselor, Licensed Clinical Social Worker, Licensed Psychologist or Licensed Marriage and… more
- City and County of San Francisco (San Francisco, CA)
- …this announcement may be appealed under Civil Service Rule 111A.35.1. The standard for the review of such appeals is 'abuse of discretion' or 'no rational basis' ... with IT partners including the DPH IT Contracts Department, UCSF clinician stakeholders, the Office of Health Informatics, Applications teams, and IT/Business… more
- Elevance Health (Waukesha, WI)
- …case reviews with attending physicians or other ordering providers to discuss review determinations. + Interprets existing policies or clinical guidelines and ... The **Plan Performance Medical Director** serves as a lead clinician and oversees the administration of medical services for...or territory of the United States when conducting utilization review or an appeals consideration and cannot… more
- Commonwealth Care Alliance (Boston, MA)
- …medical, behavioral, and social needs. The RN uses evidenced-based care approaches, clinical skills, education, and training to influence the clinical outcomes ... communities across various locations. This position reports to the CIC APC Clinical Manager. **Supervision Exercised:** No, this position does not have direct… 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