- Healthfirst (CO)
- …degree + Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case ... and Responsibilities:** + Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity,… more
- Evolent (Denver, CO)
- …- **Required** + Minimum of 5 years in Utilization Management, health care Appeals , compliance and/or grievances/complaints in a quality improvement environment- ... to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed… more
- CVS Health (Denver, CO)
- … system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. This is a ... As a Medical Director you will focus primarily on review appeal cases for denied medical services. This includes...*Two (2) or more years of experience in Health Care Delivery System eg, Clinical Practice and… more
- Humana (Denver, CO)
- …practitioner issues. manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, ... appeal or further request is warranted. The Grievances & Appeals Representative 4 + Review documents +...serve to achieve their best health - delivering the care and service they need, when they need it.… more
- Humana (Denver, CO)
- …health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director ... and communication skills + 5 years of established, post-residency clinical experience + Knowledge of the managed care... clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products +… more
- State of Colorado (Lakewood, CO)
- …conceptualizations through weekly clinical meetings with mental health staff, clinical observation of youth, communication with direct care staff regarding ... Clinical Team Leader, Behavioral Health and Medical Services...is the agency statutorily mandated to provide for the care and supervision of youth committed and detained by… more
- State of Colorado (Pueblo, CO)
- Social Work/Counselor III- Clinical Group Facilitator COT Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5039848) Apply Social Work/Counselor ... III- Clinical Group Facilitator COT Salary $82,620.00 - $115,668.00 Annually...partner. CMHHIP is a 24 hour behavioral health acute care facility that is intended to provide a safe,… more
- State of Colorado (Grand Junction, CO)
- Clinical Safety Officer III (CSO Supv III) - Grand Junction Regional Center (WESTERN SLOPE) Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5045999) Apply Clinical Safety Officer III (CSO Supv III) - Grand Junction Regional Center (WESTERN… more
- State of Colorado (Pueblo, CO)
- Clinical Security Officer I - Pueblo Regional Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5016124) Apply Clinical Security ... order to obtain life skills. Description of Job Summary of Position: The Clinical Security Officer will provide crisis intervention, to ensure the physical safety… more
- State of Colorado (Pueblo, CO)
- Clinical Safety Specialist I - CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5015553) Apply Clinical Safety Specialist I - CMHHIP ... and procedures, assists with documenting incidents related to safety violations in patient- care areas, works with the treatment teams, and assists nursing and … more