- Guardian Life (Bethlehem, PA)
- As the ** Clinical Specialist LPN/RN, Disability Claims ** you will perform necessary outreaches to claimants or treating providers to obtain certification dates, ... treatment is maintained via continuing education **You will** + Review information in file, obtain medical information needed and/or...other pertinent claim information identified. + Collaborate with the Claims Case Manager and the Claimant to… more
- Guardian Life (Bethlehem, PA)
- …as well as other pertinent claim information identified. + Collaborate with the Claims Case Manager and the Claimant to facilitate timely physician outreaches ... As the ** Clinical Specialist II, LPN/LVN** you will be a...other pertinent medical information necessary to facilitate and assist claims managers in resolving disability claims decision.… more
- BJs Wholesale Club (Marlborough, MA)
- …counsel and TPA. + Identifies claim trends and provides recommendations to the Claims Manager and Director, Risk Management, and Insurance for decreasing the ... and any required OSHA reporting. + Participates in a review of the performance of TPA's with respect to...TPA's with respect to file reviews, best practice audits, clinical consultation, service providers and claims action… more
- Molina Healthcare (Des Moines, IA)
- …Claim Experience. **Required Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, ... Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility from… more
- CenterWell (Topeka, KS)
- …community and help us put health first** As an **RCM Healthcare Claims Denials Specialist/Accounts Receivable Specialist** , you will: + Ensure the coordination ... timely reimbursement of receivables. + Research, resolve, and prepare claims that have not passed the payer edits daily....Prepare input data forms to update computer system. + Review and communicate with agencies to educate them about… more
- Children's Mercy Kansas City (Kansas City, MO)
- …can improve the lives of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, ... from admission through hospital stay to discharge. Adeptly uses evidence based clinical practice guidelines to determine the appropriate level of care and the… more
- Rush University Medical Center (Chicago, IL)
- …origin, disability, veteran status, and other legally protected characteristics. **Position** Clinical Risk Manager RN **Location** US:IL:Chicago **Req ID** ... Rush Medical Center Hospital: Rush University Medical Center Department: RUSH Risk & Claims Management **Work Type:** Full Time (Total FTE between 0.9 and 1.0)… more
- Molina Healthcare (Owensboro, KY)
- …proactively identifying, validating, and tracking cost containment initiatives through comprehensive clinical and financial analysis of claims data, medical ... execute effective Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as well as… more
- Trinity Health (Boise, ID)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** CLINICAL RISK MANAGER ** **BOISE REGIONAL MEDICAL CENTER, Level II Trauma Center** ... **SUMMARY:** The Clinical Risk Manager is to ultimately provide...concerns and identifies major trending patterns. Analyzes allegations of claims and complaints against the organization, and corresponding documentation.… more
- Baylor Scott & White Health (Temple, TX)
- …will be in Temple with travel to Waco when expected. **Job Summary** The Clinical Risk Manager (CRM) directs and coordinates clinical risk management ... integrates information from adverse events, near misses, RCAs, and clinical risk issues. With this information, the CRM reviews...learned? from study of the event. + Assists the Manager of Insurance in managing claims related… more
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