- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...documented on all patient medical records. 6. Coordinates with Care Management team when cases do not… more
- LA Care Health Plan (Los Angeles, CA)
- …Skills Required: Knowledge of state, federal and regulatory requirements in Appeals / Care /Case/Utilization Management /Quality. Strong verbal and written ... in Nursing Experience Required: Minimum of 8 years of acute/ clinical care experience. Minimum of 2 years...in a lead/supervisory experience. Equivalency: Completion of the LA Care Management Certificate Training Program may substitute… more
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Clinical Appeals Nurse Manager? At Parallon, you come first. HCA Healthcare has ... and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +...make a difference. We are looking for a dedicated Clinical Appeals Nurse Manager like you to… more
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Clinical Appeals Team Lead? At Parallon, you come first. HCA Healthcare has ... and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +...make a difference. We are looking for a dedicated Clinical Appeals Team Lead like you to… more
- HCA Healthcare (Brentwood, TN)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Appeals Nurse RN you want with your current employer? We have an exciting ... and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +...of colleagues. Do you want to work as a Clinical Appeals Nurse RN where your passion… more
- R1 RCM (Salt Lake City, UT)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse** , you will help our hospital ... clients by serving as an expert on appeals and denials management where claims were...position. **Here's what you will experience working as a Clinical Appeals Nurse:** + Conduct a detailed… more
- Penn Medicine (Philadelphia, PA)
- …of the Clinical Appeals Coordinator in all phases of the Clinical Quality and Utilization Management functions including but not limited to data entry, ... your life's work? **Summary:** Responsible for coordinating office activities for the Clinical Appeals Coordinators to assist the department in accomplishing the… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, April 29, 2024 Centers Plan for Healthy Living's goal is ... a managed care environment in related area of responsibility, (ie utilization management , quality management , grievances, and appeals ) Type of Experience… more
- CVS Health (Columbus, OH)
- …educational interventions.* Work with medical director teams focusing on inpatient care management , clinical coverage review, member appeals clinical ... and other complex health populations to optimize risk adjustment, clinical quality, and care management *...review, medical claim review, and provider appeals clinical review.* Actively participate in scheduled team meetings and… more
- Kepro (Richmond, VA)
- …In this role, you will play a pivotal role in managing and coordinating the clinical appeals process with our client. UM Clinical Reviewer: + Using ... Services and functions in a blended role as a clinical reviewer and appeals coordinator. In the...the outcomes of complaints. + Prior experience in healthcare/managed care appeals + Experience with Medicaid program… more
- Elevance Health (Atlanta, GA)
- …to attend a town hall office meeting once a quarter. The **Pharmacist - Clinical Appeals ** is responsible for managing the selection and utilization of ... pharmaceuticals and supports core clinical programs such as DUR. Primary duties may include,...in Pharmacy. + Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of… more
- Universal Health Services (Chicago, IL)
- …SUMMARY: Responsible for all denial and appeal activities for the Utilization Management department, including Expedited Appeals , Standard Appeals , External ... Independent Reviews, Retrospective Reviews, and State Fair Hearings. Review clinical information for all appeals utilizing nationally recognized criteria to… more
- Kepro (Indianapolis, IN)
- …health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job Summary: ... Our Utilization Management Appeals Nurse - LPN/RN will help...of Indiana or a Compact license. + Previous healthcare/managed care Appeals experience. + 2+ years of… more
- LA Care Health Plan (Los Angeles, CA)
- …Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... with health care access or benefit coordination issues, ensuring that clinical grievances, complaints and complex issues are investigated and resolved to the… more
- Point32Health (Canton, MA)
- …. **Job Summary** Under the general direction of the VP, the Appeals and Grievances Director is responsible for management and oversight ... doing** + The Director is responsible for leading the Appeals and Grievance Department management team and...**Experience** + Required (minimum): 10-15 experience in a managed care setting. Five to seven years of management… more
- University of Michigan (Ann Arbor, MI)
- …+ Knowledge of healthcare regulations and compliance requirements + Experience in denials management and appeals is a plus **Work Schedule** This position allows ... Inpatient Coding and Appeals Coordinator - Remote Apply Now **How to...Coordinator plays a vital role in the revenue cycle management of Rev Cycle Mid-Service by maintaining the financial… more
- Magellan Health Services (Boise, ID)
- Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests. In some cases may ... day compliance of appeal decision time frames. + Reviews clinical and medical records for completeness and determines administrative...medical necessity reviews. + Enters all data related to appeals and case reviews into a database. + Prepares… more
- Centene Corporation (Sacramento, CA)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, ... + Performs recruiting, hiring, promotion, and performance evaluation tasks and counsels non- clinical Grievance and Appeals staff. + Orients and trains new… more
- CareFirst (Baltimore, MD)
- … Clinical Medical Claims Review, Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. May lead ... week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple strategic clinical ...Licensure And/or Compact State Licensure. **Experience:** + 8 years clinical experience in care management .… more
- Elevance Health (Denison, TX)
- …clinical and non- clinical services, quality of service, and quality of care issues to include executive and regulatory grievances. **How you will make an ... management review activities that require the interpretation of clinical information. + The analyst may serve as a...may serve as a liaison between grievances & and appeals and /or medical management , legal, and/or… more