- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care . The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims ... mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …claims, and appeals to confirm medical necessity and appropriateness of care . The reviewer applies evidence-based criteria including InterQual and/or medical ... for all positions. **POSITION PURPOSE** The Behavioral Health Utilization Reviewer is responsible for conducting clinical reviews...Psychiatric Medical Director for secondary review . + Review and support the appeals department in… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …+ Participate in the development and refinement of utilization management protocols and clinical review tools. + Collaborate with internal departments such as ... Applied Behavior Analysis (ABA) services for LA Blue members. The BCBA Utilization Reviewer will review treatment plans, conduct utilization reviews, and ensure… more
- Guthrie (Troy, PA)
- …to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, other ... UM processes and operations. Experience Minimum of five years clinical experience in an acute health care ...to track and monitor the status for denials and appeals . + Participates in performance improvement and educational activities.… more
- R1 RCM (Boise, ID)
- …you will help support clinicians who conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, ... and the ability to use sound judgment in reviewing clinical documentation supporting patient care as well...position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor… more
- Centene Corporation (Atlanta, GA)
- …a collaborative, remote work environment** **This is a great opportunity to apply your clinical expertise in a non-direct care role, supporting quality care ... changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene...with a passion for improving access to behavioral health care ? Centene is looking for a Remote Psychologist to… more
- Centene Corporation (Frankfort, KY)
- …a collaborative, remote work environment** **This is a great opportunity to apply your clinical expertise in a non-direct care role, supporting quality care ... changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene...with a passion for improving access to behavioral health care ? Centene is looking for a Remote Psychologist to… more
- BJC HealthCare (St. Louis, MO)
- …and VitalWare to review documentation to write a compelling appeal. The Clinical Appeals Specialist must be able to identify trends and escalate them ... Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist for infusions! Ideal applicants...**BJC HealthCare** is one of the largest nonprofit health care organizations in the United States, delivering services to… more
- Molina Healthcare (Green Bay, WI)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within ... compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of previously denied cases in which… more
- R1 RCM (Boise, ID)
- …AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse** , you will help review and interpret medical records ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse:** + Review...only does that drive customer success and improve patient care , but that same enthusiasm is applied to giving… more