- Molina Healthcare (Warren, MI)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge… more
- US Tech Solutions (RI)
- …as needed, and transfers all clinical questions and judgement calls to the Clinical Pharmacist as needed. + The Nurse Associate LPN will also assist with ... am CST; possible weekends** **Duration: 6 Months +** **Job Description:** + The Nurse Associate LPN - Prior Authorization is responsible for the efficient, accurate… more
- Ascension Health (Wichita, KS)
- …professional licensure at time of hire. **Additional Preferences** Experience with clinical appeals preferred. Experience with denials and coding strongly ... at the time of the offer._ **Responsibilities** Coordinate payer denials and appeals , respond to insurance company requests for medical records, and perform medical… more
- Cummins Behavioral Health Systems Inc. (Avon, IN)
- …Indiana state licensure as a Registered Nurse with certification as a Clinical Nurse Specialist or Nurse Practitioner with prescriptive authority Let ... place. * If being part of a learning organization appeals to you, get in touch with us. *...throughout central and west central Indiana. The Advanced Practice Nurse , under the supervision of a Staff Psychiatrist, will… more
- Beth Israel Lahey Health (Boston, MA)
- …a Registered Nurse (RN), Massachusetts + Three years of recent clinical or utilization management experience _Preferred:_ + Bachelor's degree in nursing or ... vs. outpatient) based on medical necessity. 3. Actively seeks additional clinical documentation from the physician to optimize hospital reimbursement when… more
- Amaze Health (Denver, CO)
- …healthcare in America, one patient at a time. We're seeking a patient-focused Nurse Practitioner (NP) or Physician Assistant (PA) to join our growing team. In ... identify the root cause of symptoms and health concerns. + Integrate clinical expertise, patient history, and diagnostics to make sound, evidence-based decisions. +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the use of medical and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks essential to the efficient ... expert and occasionally works directly with the operation and clinical staff to resolve issues and escalated problems. +...not limited to UM and CM, Fair Hearings and Appeals /Grievances, within three months of working in position. +… more
- Crouse Hospital (Syracuse, NY)
- …department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow related to readmission prevention, length ... Manager, Care Coordination Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree +...care setting or other care continuum experience in a clinical setting + Knowledge of regulatory requirements related to… more
- WesleyLife (Urbandale, IA)
- …health, happiness, and daily experience of the residents at Wesley at Home. **As a Clinical Manager, you will:** + Support the Nurse Case Managers leading teams ... aides. + Retain responsibility for onboarding and education, delegating tasks to the Nurse Case Managers in coordination with the Clinical Educator. + Provide… more
- Select Medical (Dallas, TX)
- …venture with Select Medical & Baylor Scott & White Health Dallas, TX ** Clinical Intake Coordinator / Clinical Liaison (RN strongly preferred)** **Full-Time, ... Monday through Friday 8am - 5pm** **Competitive base salary with monthly bonuses!** Clinical Liaisons are advocates who educate and guide patients toward the next… more