- Centene Corporation (Topeka, KS)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. + Maintain files and logs for all appeals +… 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
- 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
- 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
- Elderwood (Cheektowaga, 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 ... Overview Managed Care Coordinator Overview The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator with case management… 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
- 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
- State of Colorado (Denver, CO)
- Medical Staff Coordinator - Administrator II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4946968) Apply Medical Staff Coordinator - ... the patients at CMHHIFL. The work unit provides administrative, clinical , strategic, and operational leadership to ensure high-quality care...by the State Personnel Director. You will find the appeals process, the official appeal form, and how to… 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
- Elevance Health (IA)
- **LTSS Service Coordinator ** _Location:_ This is a field based position. Candidate would need to meet face to face with patients in and around the following ... to client needs, and direct, hands-on engagement. The **LTSS Service Coordinator ** is responsible for conducting service coordination functions for a defined… more
- Nuvance Health (Danbury, CT)
- *Description* Summary: Works closely with the physical advisors, Clinical Denial Specialist nurses, Case managers, Case Management Operation Coordinators, and ... Insurance companies. Sends provider appeals to insurance companies including Medicare and Medicaid for...Creates a weekly assignment for director to review for appeals . 6. Communicates with insurance companies to schedule a… more
- BJC HealthCare (St. Louis, MO)
- …oncology team is expanding and is looking for an eager and detail - oriented coordinator to join our team! In this role, you will deal with complex prior ... patients receiving oral chemo medications. _This is great opportunity to expand your clinical and pharmacy knowledge._ + Remote / Work from home opportunity + Must… more
- Children's Hospital Boston (Boston, MA)
- …Job Posting Category:AdministrationJob Posting Description:The Senior Patient Administrative Coordinator will be responsible for: + Authorizations: + Managing ... families for delivery of specialized treatments during clinic visits. + Coordinating appeals with clinicians and patient families by preparing letters of appeal or… more
- Guthrie (Corning, NY)
- Position Summary: The LPN Care Coordinator will assist the providers with medication refills, patient messages, in basket monitoring, overdue results, referrals, ... of coverage of ordered medications. * *Coordinate and complete appeals for denials as needed * *Monitor and Review...care while they are not in the office LPN Clinical Care * *Dressing changes, injections, rooming and patient… more
- Rochester Regional Health (Rochester, NY)
- …the medical management department in the tracking, trending and reporting of appeals and charge recovery information. + Conducts reviews of cost outliers and ... assigned. + Provide ongoing resource and support to the department for clinical pathway process including tool development. + Manages confidential information in… more
- Corewell Health (Royal Oak, MI)
- …criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization ... adult and Level II pediatric trauma designations. The advanced capabilities and clinical expertise within this center have earned it Magnet designation four… more
- Highmark Health (Dover, DE)
- …and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials/ appeals and retrospective payer audit denials. ... degree **Preferred** + None **EXPERIENCE** **Required** + 2 years of recent clinical RN Acute care, Home care, Palliative, Hospice, or Care Management **Preferred**… more