- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4963973) Apply CDOC Registered Nurse ( Nurse I) ... $10,627.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 06/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (Denver, CO)
- CDOC Licensed Practical Nurse (LPN) - DENVER Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5100028) Apply CDOC Licensed Practical Nurse ... treatment plans, employs infection control measures, provides referral to appropriate Clinical Services staff for new arrivals, crisis intervention, interviews and… more
- Beth Israel Lahey Health (Cambridge, MA)
- …high reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, ... skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review.… more
- Garnet Health (Middletown, NY)
- …Health Medical Center. Responsibilities Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of ... to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet...day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement… more
- US Tech Solutions (Columbia, SC)
- …could be extended. + Skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral Health or infusion ... line of business. + Previous Medicare experience and /or UR experience/Process Appeals requests/can have experience in either Utilization management or Appeals .… more
- Commonwealth Care Alliance (Boston, MA)
- …and communities across various locations. This position reports to the CIC APC Clinical Manager . **Supervision Exercised:** No, this position does not have ... as approved + Supports escalation of member grievances and appeals + Supports the procurement of network providers and...care management, including: + 5+ years' experience as Registered Nurse in a high touch clinical environment… more
- Molina Healthcare (Warren, MI)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional in Healthcare… more
- University of Utah Health (Salt Lake City, UT)
- …continued stay review. + Communication to third-party payers for initial and concurrent clinical review. + Reviews patient chart to ensure patient continues to meet ... or third-party payer. + Alerts and discusses with physician/provider and case manager /discharge planner when patient no longer meets medical necessity criteria for… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and ... various health plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization Specialist is responsible for managing all work related to… more
- Beth Israel Lahey Health (Plymouth, MA)
- …multidisciplinary team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor ... establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical… more