- Cognizant (Phoenix, AZ)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical ...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… more
- Nuvance Health (Danbury, CT)
- …REQUIRED* * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- McLaren Health Care (Mount Clemens, MI)
- …outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist , or Certified Clinical Documentation Specialist certifications more
- Catholic Health (Buffalo, NY)
- …with varied hours based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the ... people, carrying out and documenting the appeals process for denied claims denied due to reasons...denied due to reasons including, but not limited to clinical documentation/support for diagnostic related grouping (DRG) assignment, inpatient… more
- City and County of San Francisco (San Francisco, CA)
- …and assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other related duties as assigned/required. ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- Stanford Health Care (Palo Alto, CA)
- …analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding ... is a Stanford Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist ...Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and… more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by ... reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review...prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization Specialist is responsible for managing...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- Veterans Affairs, Veterans Health Administration (Eagan, MN)
- …(ie, Puerto Rico), or in the District of Columbia. Occupational Therapist ( Clinical Specialist ), GS-13 Grade Requirements: Experience: In addition to meeting ... program eligibility, service delivery, location, level of care discharge planning, appeals process, and performance improvement. Conducts comprehensive clinical … more
- Veterans Affairs, Veterans Health Administration (Eagan, MN)
- …in VHA must be proficient in written and spoken English. Physical Therapist ( Clinical Specialist ), GS-13 Grade Requirements: Experience: In addition to meeting ... program eligibility, service delivery, location, level of care discharge planning, appeals process, and performance improvement. Conducts comprehensive clinical … more
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