- Molina Healthcare (North Las Vegas, NV)
- …works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, ... performing one or more of the following activities: care review /utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), case… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions (BHPS) is seeking an experienced Healthcare Claims Examiner skilled in the interpretation of Hospital and Ancillary ... adhering to the specified turnaround times. + Perform quality review of claims and logic changes/updates in Impact. +...school education is a plus. About At Brighton Health Plan Solutions, LLC, our people are committed to the… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions (BHPS) provides Case Management / Medical Management services to its clients. Clinical Coordinator facilitates case ... GED is required. + Strong skills in medical record review . + Familiarity with medical terminology a plus. +...tasks as identified and/or assigned. About At Brighton Health Plan Solutions, LLC, our people are committed to the… more
- Arc Allegany-Steuben (Bath, NY)
- …or Corporate Compliance. * Assist in the maximization of billing by ensuring review of all services/ plans are completed per Agency and regulatory expectations. ... with the person in the development of his/her Life Plan and associated Staff Action Plans . *...procedure. * Reviews service documentation to ensure the service plan is being implemented as intended. * Review… more
- Geisinger (Danville, PA)
- …Ensures all regulatory requirements are met including the completion of annual fraud plans and reports. Acts as a point of contact for collaboration with local, ... management with reimbursement or recovery recommendations based on PI team's review of claims for appropriate coding, billed statistics, policies, industry standards… more
- Brighton Health Plan Solutions, LLC (TX)
- …in a high-volume call center, experience with claims inquiry and claims review procedures, knowledge of medical specialties, fee schedules, complaints and appeals ... and voice. + Previous multi-channel experience is a plus. About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …client-facing reports, dashboards, and analyses. + Lead program performance review presentations with clinical program managers, client account managers, and ... a plus. + Experience with Predictive Analytics a plus. About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is… more
- Brighton Health Plan Solutions, LLC (NC)
- …respond to escalated issues and pertinent information on claims requiring adjudication. + Review and process High Dollar claims and conduct quality reviews of claims ... or comparable experience in the healthcare field preferred. About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how… more
- Monroe Plan for Medical Care (Oswego, NY)
- …where it matters most. As a contracted partner with Oswego County, Monroe Plan is sourcing experienced Licensed Social Workers who are committed to supporting ... re-engagement in community care, and addressing barriers to care. + Review documentation and conduct comprehensive psychosocial assessments to determine the medical,… more
- Insight Global (Norfolk, VA)
- Job Description Insight Global is looking for a Remote Director of Health Plan Business Testing for a large healthcare company. This individual must reside in one of ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/. Skills and… more