- Penn Medicine (Philadelphia, PA)
- …shape our future each day. Are you living your life's work? **Summary:** + The Clinical Appeals Coordinator will play an essential role in maximizing ... this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today...years Working as a RN Case Manager and /or Appeals Coordinator required. We believe that the… more
- Centene Corporation (Topeka, KS)
- …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
- Centene Corporation (Tallahassee, FL)
- …competitive benefits including a fresh perspective on workplace flexibility. **Pharmacy Coordinator ( Appeals ) - Florida** **Position Purpose:** Perform duties to ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- WMCHealth (Valhalla, NY)
- Asst Utilization Coordinator - Appeals Company: Westchester Medical Center City/State: Valhalla, NY Category: Nursing/Nursing Management Department: Clinical ... link Job Details: Internal Posting: 02/25/25 to 03/10/25 Assistant Utilization Coordinator Summary: Under general supervision, an incumbent of this class assists… more
- Commonwealth Care Alliance (Boston, MA)
- …, operations, pharmacy, dental, reporting, and member services. + Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day ... 011540 CCA- Appeals & Grievances **Position Summary** Appeals ...strict deadlines. + When necessary collaborate with care teams, clinical staff, family members, and other involved in providing… more
- Squirrel Hill Health Center (Pittsburgh, PA)
- …Health Center (SHHC), is a Federally Qualified Health Center (FQHC), seeking a dedicated Clinical Support Coordinator to join our team. The ideal candidate will ... and insurance companies to streamline the authorization process. The Clinical Support Coordinator will assist SHHC Providers...of approval or denial statuses, including next steps for appeals if necessary. + Documentation: + Accurately… more
- CareOregon (Portland, OR)
- …Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Pharmacy Clinical Coordinator Exemption Status Exempt Department Pharmacy Manager Title ... use reviews. + Review medication prior authorization requests and appeals . + Develop and implement clinical educational...requests and appeals . + Develop and implement clinical educational programs to improve drug utilization and quality.… more
- Elderwood (Cheektowaga, NY)
- …handles Third Party appeals , peer to peers as applicable and with clinical oversight provided by the LPN/RN MDS Coordinator . Attends team meetings at ... Overview Managed Care Coordinator Overview The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator with case management… more
- HCA Healthcare (Manchester, NH)
- …care like family! Jump-start your career as a Medical Staff Services Coordinator today with Catholic Medical Center. **Benefits** Catholic Medical Center, offers a ... Come join our team as a Medical Staff Services Coordinator . We care for our community! Just last year,...play a key role in the integration of HCA Clinical Strategies and HCA systems. 1. Medical Staff Administration… more
- Centene Corporation (Tacoma, WA)
- …with customer expectations and lead clinical quality initiatives. Review clinical information for appeals to determine medical necessity of services, ... + Lead Behavioral Health Performance Improvement Projects (PIPS) + Review clinical information for appeals to determine medical necessity + Prepare cases for … more