- Cognizant (Salt Lake City, UT)
- …, and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews .… more
- Evolent (Salt Lake City, UT)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators… more
- Molina Healthcare (Salt Lake City, UT)
- …set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review summaries, bill… more
- University of Utah Health (Salt Lake City, UT)
- …stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient continues to meet ... expected LOS, expected cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by nursing judgment and/or… more
- Molina Healthcare (West Valley City, UT)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses...+ Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the… more