- Guardian Life (Bethlehem, PA)
- As the ** Clinical Specialist LPN/RN, Disability Claims ** you will perform necessary outreaches to claimants or treating providers to obtain certification dates, ... treatment is maintained via continuing education **You will** + Review information in file, obtain medical information needed and/or...other pertinent claim information identified. + Collaborate with the Claims Case Manager and the Claimant to… more
- CenterWell (Topeka, KS)
- …community and help us put health first** As an **RCM Healthcare Claims Denials Specialist/Accounts Receivable Specialist** , you will: + Ensure the coordination ... timely reimbursement of receivables. + Research, resolve, and prepare claims that have not passed the payer edits daily....Prepare input data forms to update computer system. + Review and communicate with agencies to educate them about… more
- Children's Mercy Kansas City (Kansas City, MO)
- …can improve the lives of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, ... from admission through hospital stay to discharge. Adeptly uses evidence based clinical practice guidelines to determine the appropriate level of care and the… more
- Rush University Medical Center (Chicago, IL)
- …origin, disability, veteran status, and other legally protected characteristics. **Position** Clinical Risk Manager RN **Location** US:IL:Chicago **Req ID** ... Rush Medical Center Hospital: Rush University Medical Center Department: RUSH Risk & Claims Management **Work Type:** Full Time (Total FTE between 0.9 and 1.0)… more
- Trinity Health (Boise, ID)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **NON- CLINICAL RISK MANAGER ** **SUMMARY:** The Non- Clinical Risk Manager is to ... Reassign events to appropriate department/clinic leadership and/or to peer review . + Ascertain clinical course of patient...process, including Common Cause Analysis (CCA) as needed. + Non- Clinical Risk Manager will work with legal… more
- Otsuka America Pharmaceutical Inc. (Baton Rouge, LA)
- **Job Summary** Manager , Clinical Supply Operations manages Phase I-IV clinical studies, including coordination of packaging, labeling, blinding of ... FDA, EU and country specific requirements. + Write or review the Study Medication Sections of the Clinical...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Prime Therapeutics (Oklahoma City, OK)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Clinical Account Manager - Georgia PDL - Remote **Job Description** Innovative ... + Provides clinical operations input and support of client specific claims processing programs, coordinates implementations of clinical projects and programs… more
- Centers for Independence (Milwaukee, WI)
- …Percentage** Minimal; Less than 10% **Job Shift** Day **Description** **Job Purpose:** The clinical manager is responsible for organizing and directing the daily ... the performance of all staff who report to the clinical manager including formal reviews and performance...clients' nursing care based upon skilled assessment, medical record review , the client's plan of treatment, and communication with… more
- Intellatriage (Brentwood, TN)
- …in a rapidly growing, patient-focused business. We are actively recruiting a talented Clinical Care Manager to join our team of energetic, compassionate ... is responsible for managing a team who focuses on distinguishing between clinical and non- clinical issues, managing communication, reducing unnecessary hospital… more
- CareOregon (Portland, OR)
- …Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Clinical Operations Manager Department Clinical Operations Exemption Status ... Exempt Requisition # 24994 Direct Reports Team Supervisors and Support Staff Manager Title Director, Clinical Operations Pay & Benefits Estimated hiring range $… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …third party administrators, utilization review and management requirements. The Manager of Compliance and Clinical Operations will also have oversight ... and programs. **Job Summary:** Reporting to the Director of Operations, the Manager of Compliance and Clinical Operations is responsible formaintaining an… more
- PeaceHealth (Florence, OR)
- **Description** PeaceHealth is seeking a Clinical Risk Manager for a Full Time, 1.00 FTE, Day position. The salary range for this job opening at PeaceHealth is ... approach. + Performs investigations and responds to incidents/events, potential claims , and grievances presented against caregivers, physicians and the organization… more
- Masonicare (Wallingford, CT)
- RN Manager Clinical Reimbursement Job Location: Wallingford Center, Connecticut RN Manager Clinical Reimbursement Masonicare Health Center - Wallingford, ... CT Day Shift / 40hrs/wk The Manager Clinical Reimbursement is responsible for coordinating,...Organize and participate in the daily Medicare meeting, utilization review and monthly end of close meetings. + Assists… more
- Trinity Health (Albany, NY)
- … CLAIMS SUPPORT:** Works collaboratively with assigned Trinity Health Area Claims Manager and defense counsel to support discovery requests (access ... Full time **Shift:** Day Shift **Description:** **TITLE** Risk Analyst/Specialist **DEPARTMENT:** Clinical Quality & Safety **REPORTS TO:** Risk Manager … more
- Trinity Health (Syracuse, NY)
- … CLAIMS SUPPORT:** Works collaboratively with assigned Trinity Health Area Claims Manager and defense counsel to support discovery requests (access ... requested.** Other duties as assigned- including but not limited to supporting clinical risk management (such as event review , event reporting,… more
- Beth Israel Lahey Health (Plymouth, MA)
- …you're making a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** ... Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:**...deficiencies. + Facilitates peer-to-peer communication in support of submitted claims . + Participates on the Utilization Review … more
- Stryker (Portage, MI)
- …to ensure continued product availability. Help translate clinical data into new claims for existing products. + Review marketing collateral for accuracy of ... independently with minimal supervision. **What you will do** + Act as the dedicated clinical evaluation project manager , driving the establishment of a coherent … more
- Molina Healthcare (WI)
- …+ Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience ... identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review summaries, bill… more
- Elevance Health (Costa Mesa, CA)
- … documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will ... make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, ...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Premier Health (Dayton, OH)
- …of trends and reporting this information to leaders, executives and Quality Innovation. The manager participates in routine claims review meetings with the ... the assets of the organization and through (a) proactive clinical and operations risk management and (b) claims...and litigation management. o In the performance of proactive clinical and operations risk management, the Risk Manager… more
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