- Corewell Health (Royal Oak, MI)
- …criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization ... adult and Level II pediatric trauma designations. The advanced capabilities and clinical expertise within this center have earned it Magnet designation four… more
- CareFirst (Baltimore, MD)
- …authorization of services and approved claims. + Prepares retrospective reviews, case appeals , billing coordination, and clinical support. + Manages the analysis ... to the required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership… more
- Eastern Connecticut Health Network (Manchester, CT)
- …with the interdisciplinary team. Communicates, as appropriate, the patient's clinical condition and care needs. Demonstrates knowledge of the principles ... + Must have a current license as a Registered Nurse in the State of Connecticut . + Professional...Connecticut . + Professional certification in case management or clinical specialty is preferred. EXPERIENCE + Must have at… more
- Louisiana Department of State Civil Service (Shreveport, LA)
- …the CONSAH Health Services Department, including supervision of the Health Services Nurse , to ensure student clinical credentialing, immunization compliance, and ... 4, 2025. Academic rank and salary commensurate with qualifications and experience. Review of applications will begin immediately. The position will remain open until… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …and Statistical Manual of Mental Disorders, written treatment orders, admissions on-call review for all legal commitment status documents and review and ... Leadership & Supervision - Assume a leadership role regarding the clinical management of patients/clients in programs assigned. Establish as necessary… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …history and physical examination, either written or dictated. This includes a review of the immunization status, allergies, past history, family history and ... Leadership & Supervision - Assume a leadership role regarding the clinical management of patients/clients in programs assigned. Establish as necessary… more
- Alameda Health System (San Leandro, CA)
- …Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or experience in ... other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic plans. Makes… more
- Corewell Health (Dearborn, MI)
- …criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization ... + Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). + Responsible for managing… more
- Catholic Health Services (West Islip, NY)
- …not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure ... the most advantageous clinical and financial outcomes. + Supports all CH and...of Participation. + Implements care management programs, including utilization review , intake and discharge planning. + Evaluates patient care… more
- Calvary Hospital (Bronx, NY)
- …to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts ... interdepartmental meetings related to the quality and utilization of clinical services. Serves on various Hospital committees as assigned. Attends meetings and… more