- MedStar Health (Baltimore, MD)
- Candidates with previous Utilization Review or Denials / Appeals experience preferred General Summary of Position Responsible for coordinating and monitoring the ... denial management and appeals process. Combines clinical , business and regulatory...Assists in the orientation of new staff regarding the denials and appeals process. May manage the… more
- Jewish Family Services, Inc (Milwaukee, WI)
- …and communication skills to agency clients and BillCare. Reports directly to the Director of Clinical Services.. Duties and Responsibilities : Clinical ... or processing errors based on tickets received from BillCare. Inform Controller and Director of Clinical Services of observed billing issues with specific payers… more
- Children's Mercy KC (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
- Franciscan Missionaries of Our Lady Health System (Baton Rouge, LA)
- …provided and minimize consumption of resources. e. Triages concurrent denials for potential P2P opportunities. f. Collaborates with facility-based physicians, ... the admission status and post-acute placement. g. Collaborates with Centralized Denials Management Department to coordinated appeal efforts to secure claim… more
- Catholic Health Services (Fort Lauderdale, FL)
- …and facilitate resolution of all denied claims. Including identifying and communicating to Director root causes and trends resulting in denials (CBO; Facility; ... (ie, authorizations, NOCA's, etc.) are received and included on claims, appeals are submitted within appropriate timeframe. This includes the overall compliance… 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
- Humana (Frankfort, KY)
- …_Outcomes_ : Characterize the impactable drivers of prior authorization and look at appeals rate with denials and overturns. Deliver the upmost consistent ... are seeking an accomplished healthcare physician leader for the newly-created role of Director , Physician Leadership. In this role, you will be a key enterprise… 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
