- Premera Blue Cross (Mountlake Terrace, WA)
- …serve through our Healthsource blog: https://healthsource.premera.com/ . The ** Care Coordinator ** - ** Clinical Appeals ** performs prospective review ... Care Services and Claims to ensure appropriate cost-effective care by applying their clinical knowledge and critical thinking skills to assess the medical… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …seeking a highly motivated and results-driven **UM RN Appeals Coordinator .** This role collaborates with clinical review staff, medical directors/physician ... reviewers, network physicians, and network facilities to ensure consistent clinical evaluation and processing of medical necessity appeals . Accurate… more
- Jobleads-US (Chicago, IL)
- …for appropriate tests or procedures and facilitates the process with managed care and the clinical team. Documents all information and authorization ... these plans; Works closely with the staff on managed care and referral related issues; communicates findings to patients....findings to patients. Coordinates the pre-certification process with the clinical staff as it relates to procedures in the… more
- Catholic Health Services (Melville, NY)
- …Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate utilization ... payors. + Serves as a liaison between patient account services, physicians, care coordinators, Utilization and Appeals Managers, physician advisors and facility… more
- CVS Health (Carson City, NV)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple...a plus. Fast Turn Around of inventory, collaboration with clinical team and management. Attention to detail is needed… more
- CVS Health (Harrisburg, PA)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from… more
- Nuvance Health (Danbury, CT)
- …5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician ... to inquiries and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal… more
- CommonSpirit Health (Englewood, CO)
- …We are seeking a highly skilled individual to develop and submit clinical appeals , expertly crafting physician-aligned letters based on federal and ... regulations, including CMS rules and the Two-Midnight Rule, while leveraging clinical criteria and prioritizing medical necessity to defend inpatient status. This… more
- Select Medical (Dallas, TX)
- …joint venture with Select Medical & Baylor Scott & White Health Dallas, TX ** Clinical Intake Coordinator / Clinical Liaison (RN strongly preferred)** ... Disabled/Veterans_ Apply for this job (https://jobs-selectmedicalcorp.icims.com/jobs/342545/ clinical -intake- coordinator neurotransitional-center-%28-rn-strongly-preferred-%29/job?mode=apply&apply=yes&in\_iframe=1&hashed=1374627814) Share… more
- Touro University (Hawthorne, NY)
- Overview A professional and productive clinical educational coordinator (CEC) plays a significant role in the day-to-day administration of a successful medical ... also a central point of contact for faculty and administrators from affiliated clinical sites where students are assigned to clerkship and elective rotations. This… more
