- Centene Corporation (Salem, OR)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. + Maintain files and logs for all appeals +… more
- Providence (OR)
- …the best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care ... + Oregon **Required qualifications for this position include:** + 5+ years clinical nursing experience + Experience working with physicians in the collaboration and… more
- Cardinal Health (Salem, OR)
- …obtain authorization for all requested procedures, tests, drugs, etc. The Senior Coordinator , Benefits Eligibility and Authorization may be asked to perform other ... to not delay patient care. + Complete any pre-service appeals to obtain paying approval based on medical necessity....medical necessity. + Communicate effectively with all RCM and clinical staff to ensure appropriate treatment can be provided,… more
- Highmark Health (Salem, OR)
- …obtain necessary and/or additional information when necessary. + Consult with staff clinical pharmacist for guidance and assistance as necessary. + Document all ... through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical staff. +… more