- Guthrie (Binghamton, NY)
- …and complete appeals for denials as needed + Monitor and Review REMS clearance for monthly refills of high-risk medications ordered for patients Monitor ... monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years'...and Outgoing + Sick calls - collect data for review , assessment and instruction from RN or Provider +… more
- Sharp HealthCare (San Diego, CA)
- …patient care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure ... experience or case management experience. + 3 Years case management, utilization review , care coordination experience. + California Registered Nurse (RN) -… more
- Sharp HealthCare (La Mesa, CA)
- …patient care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure ... advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers. Review all cases with readmission within… more
- Sharp HealthCare (San Diego, CA)
- …patient care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure ... advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers. Review all cases with readmission within… more
- Brockton Hospital (Brockton, MA)
- …external review agencies, to coordinate activities involved in medical record review , denials, appeals and reconsideration hearings. Works closely with the ... include the development and supervision of staff (RNs, LPN's,SWs and non- clinical support), evaluation and maintenance of case management skills and outcomes,… more
- Corewell Health (Grand Rapids, MI)
- …and participation in denials management which include review of previous clinical decisions by Priority Health Medical Directors ( appeals ). There will be ... the guiding principles will be demonstrated through applications of evidence-based utilization review process and application of sound clinical judgement. The… more
- Texas Health Resources (Arlington, TX)
- …days, etc. Medical necessity criteria, patient status, and discharge criteria. All clinical and transition documentation Clinical Review staff requirements ... the following: Compliance with program expectations Mitigation activities with all clinical partners / payors as needed. Compliance requirements: Code 44… more
- Texas Health Resources (Frisco, TX)
- …days, etc. Medical necessity criteria, patient status, and discharge criteria. All clinical and transition documentation Clinical Review staff requirements ... the following: Compliance with program expectations Mitigation activities with all clinical partners / payors as needed. Compliance requirements: Code 44… more
- Highmark Health (Pittsburgh, PA)
- …and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials/ appeals and retrospective payer audit denials. ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …needs across the continuum of care by leveraging member partnership, pre-service clinical utilization review , case and disease management processes, skill sets ... * Identifies opportunities for connecting members to group related benefits; eg Nurse Line, Employee Assistance Program, or other specialists with in BCBS Health… more