- Cognizant (Annapolis, MD)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …denial and track in log daily. + Knowledge: Demonstrate a working knowledge of Medical Necessity and regulatory standards ( Medicare , Medicaid and Manage Care) + ... RANGE: LVN/LPT $31.50-37.50 Per Hour RN/LCSW/LMFT/LPCC $54.00-64.00 Per Hour REPORTS TO: Director of Utilization Review DESCRIPTION OF POSITION: Work as member of… more
- State of Colorado (Golden, CO)
- …the facility clinic in a fiscally minded manner. Main contact with the DYS Medical Director for consultation and collaboration on individual cases. Oversees the ... up on recommendations made by those providers. Collaborates directly with the DYS Medical Director and/or other providers to determine referrals to other… more
- State of Colorado (Denver, CO)
- …the facility clinic in a fiscally minded manner. Main contact with the DYS Medical Director for consultation and collaboration on individual cases. Oversees the ... up on recommendations made by those providers. Collaborates directly with the DYS Medical Director and/or other providers to determine referrals to other… more
- State of Colorado (Pueblo, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... and communicate to the applicable WM critical issues, legal matters, potential lawsuits/ appeals , and complaints. + Research the appropriate action or person to… more
- University of Southern California (Alhambra, CA)
- …specific to ICD-10-CM, ICD-10-PCS, CPT/HCPCS, DRGs, APCs, and Modifiers-from Medicare , Medi-Cal, MAC, RAC, and commercial insurance companies -when there ... appeal. Performs all 1st and 2nd level coding-related denial appeals . All tasks & duties to be perform in...coding of all diagnostic and procedural information from the medical records using ICD-10-CM, ICD-10-PCS, and CPT/HCPCS, and Modifier… more
- State of Colorado (Denver, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... and jail evaluations statewide. This position reports to the Operations Director and supports contracted services provided to the Forensic Services Department.… more
- State of Colorado (CO)
- …of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director , Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver, ... enriching professional development opportunities and a wide range of benefits. + Medical and dental options are available for permanent employees and their… more
- State of Colorado (Grand Junction, CO)
- …the facility clinic in a fiscally minded manner. Main contact with the DYS Medical Director for consultation and collaboration on individual cases. Oversees and ... specialty care and recommendations made by providers. Collaborates directly with the DYS Medical Director and/or other providers to determine referrals to other… more
- State of Colorado (Pueblo, CO)
- …the facility clinic in a fiscally minded manner. Main contact with the DYS Medical Director for consultation and collaboration on individual cases. Oversees and ... specialty care and recommendations made by providers. Collaborates directly with the DYS Medical Director and/or other providers to determine referrals to other… more