- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding ... adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical ...and mandates. + Organizes the appeal case for physician review by compiling clinical , contractual, medical policy… more
- Molina Healthcare (Houston, TX)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired… more
- State of Colorado (Pueblo, CO)
- MENTAL HEALTH CLINICIAN I - Continuity of Treatment Office- CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5171325) Apply MENTAL ... HEALTH CLINICIAN I - Continuity of Treatment Office- CMHHIP Salary...treatment programming in all CMHHP patient units by managing clinical staff call-offs and deployment in order to minimize… more
- University of Southern California (Los Angeles, CA)
- …a group of senior faculty clinicians; hold weekly small group meetings; provide clinical consultation; review and approve time off and continuing education ... are strongly committed to providing excellent multiculturally and trauma-informed clinical treatment, training, advocacy, prevention, and outreach services. We are… more
- State of Colorado (Pueblo, CO)
- CDOC Mental Health Clinician (Social Worker/Counselor III) - PUEBLO Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5190911) Apply CDOC Mental ... Health Clinician (Social Worker/Counselor III) - PUEBLO Salary $6,885.00 -...for inmates experiencing acute mental health crisis. + Renders clinical direction to non- clinical staff in mental… more
- State of Colorado (Denver, CO)
- Mental Health Clinician I - Colorado Mental Health Hospital in Fort Logan Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5197120) Apply ... Mental Health Clinician I - Colorado Mental Health Hospital in Fort...addresses safety violations in patient care areas. Using therapeutic clinical skills, anticipates and initiates intervention at an appropriate… more
- State of Colorado (CO)
- …abilities, and competencies necessary to the position through continuing education, clinical supervision, literature review , and discipline and team development. ... Health Professional III - Clinician Forensics Jail Based Restoration Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5201936) Apply Health… more
- Molina Healthcare (Tacoma, WA)
- …(Team will work on set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical … more
- City and County of San Francisco (San Francisco, CA)
- …and + May perform Quality Improvement activities such as chart audit and compliance review . + The 2932 Senior Behavioral Health Clinician performs related duties ... Then, submit an online application. Under direction, the 2932 Senior Behavioral Health Clinician performs essential duties that include, but are not limited to the… more
- LA Care Health Plan (Los Angeles, CA)
- …Oversees end-to-end clinical case handling, including clinical grievances, clinical appeals , medical necessity review coordination, and clinical ... for medical necessity reviews, clinical grievances and appeals , Quality of Care (QOC) referrals, clinician ...and appeals , Quality of Care (QOC) referrals, clinician coordination, clinical documentation quality, and regulatory… more