- US Tech Solutions (Columbia, SC)
- …team works with multiple applications to process authorization and appeals requests using Medicare criteria. **Responsibilities:** + Reviews and evaluates ... medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical … more
- Omaha Children's Hospital (Omaha, NE)
- …and obtains appropriate physician documentation while patients are in-house for clinical conditions and procedures to support the appropriate severity of illness, ... and complexity of care of the patient. Exhibits sufficient knowledge of clinical documentation requirements. APR-DRG assignment and clinical conditions and… more
- Catholic Health (Buffalo, NY)
- …for training and mentoring Utilization Review, Clinical Documentation Integrity and Clinical Denials and Appeals teams. They ensure the teams receive ... coverage as needed Summary: The Middle Revenue Cycle - Clinical Supervisor, as an active member of the Middle...+ Bachelor of Science Nursing (BSN) degree + Registered Nurse with a current New York State license CERTIFICATION… more
- Nuvance Health (Danbury, CT)
- …and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering with local case ... appeals specialists to meticulously investigate denied claims, prepare comprehensive appeals , and collaborate with clinical staff to ensure successful… more
- Texas Health Resources (Arlington, TX)
- …* Master's Degree Counseling or Social Work Required Experience * 3 Years Clinical psychiatric or chemical dependency experience Required and * 6 Months in case ... Worker Upon Hire Required Or * LCSW - Licensed Clinical Social Worker Upon Hire Required Or * LPC...Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the treatment team.… more
- Sharp HealthCare (San Diego, CA)
- …1 **Shift Start Time** **Shift End Time** Other; California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours** ... care. **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program. + California Licensed Vocational Nurse (LVN) - CA… more
- Molina Healthcare (Tacoma, WA)
- …for a RN with experience with appeals , claims review, and medical coding . JOB DESCRIPTION Job SummaryProvides support for clinical member services review ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members… more