- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …Direct and support physician review to ensure timeliness, accuracy and reliability of UM and Appeals reviews\. + Lead and serve on various committees in order to ... Provides clinical leadership and serves as an internal medical...work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability\. + Outstanding… more
- HCA Healthcare (Hendersonville, TN)
- …optimum patient experience. **What you will do in this role:** + You will lead clinical performance expectations that support the goals of consistent clinical ... consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials process, discharge planning, case… more
- Humana (Nashville, TN)
- …resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
- Humana (Nashville, TN)
- …resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal… more
- Humana (Nashville, TN)
- …and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, ... reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services.… more