- 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
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim denial ... analyzes medical records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a working knowledge… more
- Bassett Healthcare (Cooperstown, NY)
- …facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and ... methodologies in evaluating outcomes of care + Support and coaching of clinical documentation efforts + Coordinating communication with physicians Must be able to… more
- CVS Health (Franklin, TN)
- …+ Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. + Performs review of member claim history to ensure ... accordance with contract. + Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider)… more
- CVS Health (IL)
- …Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs review of member claim history to ensure ... in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider)… more
- Centene Corporation (Jefferson City, MO)
- …Purpose:** Responsible for leading clinical coding compliance nurses and non- clinical team members through medical claim review . Ensure compliance with ... coding practices through a comprehensive review and analysis of medical claims, medical records, claims...and implements best practices and operational efficiencies + Researches clinical and coding questions and issues + Triages and… 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
- Cedars-Sinai (Beverly Hills, CA)
- …their needs, coordinating care, communicating with health plans, including concurrent review to determine the appropriateness of services rendered and to ensure ... Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas'...of care and level of care. Use evidence based review guidelines to conduct utilization review as… 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
- Montrose Memorial Hospital (Montrose, CO)
- …Denial Management Program and is responsible for completing, tracking, and reporting clinical denial review determinations. This individual will combine ... Montrose, CO, USA | Clinical Revenue Integrity | Hourly | 34.10-54.56 per...or denial management. Experience with business letter writing, eg, appeals , preferred. + Must at least be Licensed as… more