• UR Clinical Specialist

    Community Health Systems (Franklin, TN)
    …management policies. This role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating...insurance companies to secure coverage approvals and mitigate concurrent denials by submitting reconsiderations or coordinating peer-to-peer reviews. +… more
    Community Health Systems (07/29/25)
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  • Specialist-Denial II RN

    Baptist Memorial (Memphis, TN)
    …extensive knowledge of payer guidelines and BMHCC contracts as it pertains to authorization and clinical denials as well as clinical audits. + Requires a ... the entire appeal process and determines if escalation to manager or payer is next step to get a...of entry to discharge when responding to technical authorization denials . + Compiles, analyzes, and distributes pertinent clinical… more
    Baptist Memorial (07/11/25)
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  • Coding Spec-Clinic

    Covenant Health Inc. (Knoxville, TN)
    …Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals , and verifies that appropriate chargemaster rates are used. ... and hospital personnel to ensure qualifying diagnosis covers tests/procedures. + Analyzes denials and coordinates appeals . + Ensures corrective action is taken… more
    Covenant Health Inc. (08/04/25)
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  • Technician-Specialty Pharmacy

    Baptist Memorial (Memphis, TN)
    …individual in this position supports the BSP Director, BSP Pharmacy Staff and Clinical Pharmacists to ensure that all duties as assigned are fulfilled accordingly. ... to prevent gaps in treatment + Support BSP pharmacists to manage the appeals process for patients and ensure timely communication occurs + Understand The Centers… more
    Baptist Memorial (08/13/25)
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