- Beth Israel Lahey Health (Plymouth, MA)
- …establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical ... team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding… more
- Beth Israel Lahey Health (Plymouth, MA)
- …establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical ... team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding… more
- Providence (OR)
- …best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care ... are terminal and nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing day to day… more
- UHS (Binghamton, NY)
- Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this vital role, ... you will focus on the prevention and resolution of clinical claim denials by analyzing denial patterns, investigating and appealing denied claims, and collaborating… more
- Garnet Health (Middletown, NY)
- …rural life, we invite to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet Health Medical Center. Responsibilities ... Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of...day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient… more
- Nuvance Health (Danbury, CT)
- …and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering with local case ... specialists to meticulously investigate denied claims, prepare comprehensive appeals , and collaborate with clinical staff to...nurse (RN) * Minimum of 5 years of clinical experience in an acute care setting * Minimum… more
- CVS Health (Charleston, WV)
- …Managers, Manager, and other key stakeholders such as Medical Directors, account teams/ clinical liaisons, etc.) to ensure consistency in clinical interventions ... of utilization management services for assigned area + Implements clinical policies & procedures in accordance with applicable regulatory...+ 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience +… more
- Trinity Health (Des Moines, IA)
- …Join the MercyOne Family! We are looking to hire a RN Clinical Integration Specialist. The purpose of the Clinical Integration Specialist ... for Medicare and Medicaid Services (CMS), Iowa Department of Inspections and Appeals (IDIA), The Joint Commission (TJC),etc.), in conjunction with the hospital's… more
- Virtua Health (Mount Laurel, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... Coding Audit Response: Conducts Trains new coders to utilize the medical record, clinical , coding and abstracting systems, in conjunction with UHDDS and other rules… more