- Sharp HealthCare (San Diego, CA)
- …with the Chief Medical Officer (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is ... responsible for non- clinical appeals and grievances. **Required Qualifications** + 3 years' experience in claims, utilization review, appeals or member… more
- Sharp HealthCare (San Diego, CA)
- …with the Chief Medical Officer (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is ... responsible for non- clinical appeals and grievances. **Required Qualifications** + 3 years' experience in claims, utilization review, appeals or member… more
- Penn Medicine (Bala Cynwyd, PA)
- …employees shape our future each day. Are you living your life's work? **Data Coordinator , Government Audits and Appeals ** Job Summary: + The Data Coordinator ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- CVS Health (Sacramento, CA)
- …Summary** Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more
- Munson Healthcare (Traverse City, MI)
- …and initiating the authorization process. 10. Identifies and facilitates appeal responses, gathers clinical packets for appeals , and follows up on appeals ... experience in a revenue cycle role (billing, registration, insurance verification, referral coordinator , etc) . Ability to work independently and problem solve with… more
- Centene Corporation (Phoenix, AZ)
- …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, ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… 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
- UNC Health Care (Goldsboro, NC)
- … denials for validity and probability to overturn, proactively gathers required clinical documentation and formulates appropriate appeals . Coordinates the denial ... **Description** Summary: Coordinates and leads all clinical denial processes and clinical audit...Advisors and subject matter experts for all audit and appeals work activities. Assists with documentation review to support… more
- CareOregon (Portland, OR)
- …Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Pharmacy Clinical Coordinator Exemption Status Exempt Department Pharmacy Manager Title ... use reviews. + Review medication prior authorization requests and appeals . + Develop and implement clinical educational...requests and appeals . + Develop and implement clinical educational programs to improve drug utilization and quality.… more
- Providence (OR)
- …the best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care ... + Oregon **Required qualifications for this position include:** + 5+ years clinical nursing experience + Experience working with physicians in the collaboration and… more