- Centene Corporation (Salem, OR)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. + Maintain files and logs for all appeals +… more
- Catholic Health Services (Melville, NY)
- …Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate utilization ... management and appeals functions to include coordination of specific process and...+ Ability to utilize critical thinking and apply sound clinical judgment and assessment skills for decision-making. + Knowledge… more
- Motion Recruitment Partners (Birmingham, AL)
- Claims Appeals and Grievance Coordinator Birmingham, Alabama **Onsite** Contract $18/hr - $28/hr Are you detail-oriented, highly organized, and passionate about ... making a difference in healthcare? We are seeking several Appeals and Grievances Coordinators for an onsite contract opportunity in Birmingham, AL. In this role,… more
- CVS Health (Carson City, NV)
- …9am-1pm.** Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more
- CVS Health (Phoenix, AZ)
- …supports the daily processing of appeals in the Commercial Member Clinical Appeals (CMCA). Job functions include, completing appeals determination ... as necessary, supporting the panel hearing process, working collaboratively with clinical support staff (Medical Directors, Nurses, Providers, etc.), triage of… more
- Nuvance Health (Danbury, CT)
- …5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician ... and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in… more
- CommonSpirit Health (Englewood, CO)
- …We are seeking a highly skilled individual to develop and submit clinical appeals , expertly crafting physician-aligned letters based on federal and ... regulations, including CMS rules and the Two-Midnight Rule, while leveraging clinical criteria and prioritizing medical necessity to defend inpatient status. This… more
- Select Medical (Dallas, TX)
- …joint venture with Select Medical & Baylor Scott & White Health Dallas, TX ** Clinical Intake Coordinator / Clinical Liaison (RN strongly preferred)** ... Disabled/Veterans_ Apply for this job (https://jobs-selectmedicalcorp.icims.com/jobs/342545/ clinical -intake- coordinator neurotransitional-center-%28-rn-strongly-preferred-%29/job?mode=apply&apply=yes&in\_iframe=1&hashed=1374627814) Share… more
- Touro University (Hawthorne, NY)
- Overview A professional and productive clinical educational coordinator (CEC) plays a significant role in the day-to-day administration of a successful medical ... also a central point of contact for faculty and administrators from affiliated clinical sites where students are assigned to clerkship and elective rotations. This… more
- Providence (Beaverton, OR)
- …the best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care ... + Oregon **Required qualifications for this position include:** + 5+ years clinical nursing experience + Experience working with physicians in the collaboration and… more