- Penn Medicine (Philadelphia, PA)
- …shape our future each day. Are you living your life's work? **Summary:** + The Clinical Appeals Coordinator will play an essential role in maximizing ... this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today...years Working as a RN Case Manager and /or Appeals Coordinator required. We believe that the… more
- VNS Health (Manhattan, NY)
- …and advancement opportunities What You Will Do + Identifies case types (eg- clinical vs non- clinical appeals ) during the intake process, communicates ... provides administrative support to staff, including tasks such as clinical case file preparation for appeals . This...such as clinical case file preparation for appeals . This includes retrieving documents from related systems (such… 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
- CVS Health (Harrisburg, PA)
- …issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from ... outside plan sponsors or regulators. * Research and resolves incoming electronic appeals as appropriate as a "single-point-of-contact" based on type of appeal. *… more
- Centene Corporation (Phoenix, AZ)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... support and direction for the daily operations of the appeals function + Provide consultation for problem resolution for... function + Provide consultation for problem resolution for appeals staff and monitor team work output to ensure… more
- WMCHealth (Valhalla, NY)
- Asst Utilization Coordinator - Appeals Company: Westchester Medical Center City/State: Valhalla, NY Category: Nursing/Nursing Management Department: Clinical ... link Job Details: Internal Posting: 02/25/25 to 03/10/25 Assistant Utilization Coordinator Summary: Under general supervision, an incumbent of this class assists… more
- Squirrel Hill Health Center (Pittsburgh, PA)
- …Health Center (SHHC), is a Federally Qualified Health Center (FQHC), seeking a dedicated Clinical Support Coordinator to join our team. The ideal candidate will ... and insurance companies to streamline the authorization process. The Clinical Support Coordinator will assist SHHC Providers...of approval or denial statuses, including next steps for appeals if necessary. + Documentation: + Accurately… more
- Healthfirst (NM)
- …the option of 4x10 or 5x8 work schedules** + Prepare cases for the clinical team by gathering documentation, loading evidence, and making calls to members and ... + Correctly and completely preps completed case files for clinical review. + Notifies team lead of identified patterns...review. + Notifies team lead of identified patterns of appeals , claim errors, configuration issues or other systemic problems… more
- CVS Health (Baton Rouge, LA)
- …day. **Position Summary** Responsible for intake, investigation and resolution of appeals , complaints and grievances scenarios for all products, which may contain ... responses from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance. Identify trends and emerging issues and report… more
- Community Health Systems (Fort Smith, AR)
- **Job Summary** The Remote Denial Coordinator - Registered Nurse - PRN is responsible for reviewing, tracking, and resolving denied claims, ensuring that appropriate ... appeals are submitted, and working closely with payers, internal...Communicates with key stakeholders across revenue cycle, billing, and clinical teams to resolve denial trends and improve claim… more
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