- Veterans Affairs, Veterans Health Administration (Eagan, MN)
- …program eligibility, service delivery, location, level of care discharge planning, appeals process, and performance improvement. Conducts comprehensive clinical ... team (IDT) responsible for providing centralized, standardized, administrative and clinical eligibility reviews for authorization of purchased in home services.… 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
- Mount Sinai Health System (New York, NY)
- …for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status… more
- Children's Mercy Kansas City (Kansas City, MO)
- …review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital ... training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing… more
- Houston Methodist (Sugar Land, TX)
- …responsible for performing utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration ... management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for… more
- State of Colorado (Denver, CO)
- …hormone treatment, receiving referrals for gender affirming procedures. + Facilitate review of gender affirming treatment referrals by the Gender Dysphoria Treatment ... in other committees as assigned. + Perform offender health record reviews; + Review laboratory, x-ray and EKG results and intervene as medically indicated; + Perform… more
- Elevance Health (Morristown, NJ)
- …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... ** Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical...and supportive care. + Perform physician-level case review , following initial nurse review ,… more
- State of Colorado (Pueblo, CO)
- …Participates in the QA/PI process at the unit level as directed by the Lead Nurse . + Attends weekly nursing rounds or read/ review and understand information in ... deliver nursing care and therapeutic interventions under the supervision of a registered nurse . The Client Care Aide II provides nursing care as assigned (ie… more
- Mount Sinai Health System (New York, NY)
- …for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). ... plan of care and coordination of services based on clinical needs and available resources. 3. Utilization Review...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …related field * Minimum 3 years of experience in clinical care, utilization review , case management, or clinical denials/ appeals -OR- * An approved ... CMS criteria * Collaborate with UM staff to draft and submit compelling clinical appeals , including summaries and supporting documentation in accordance with… more