- 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
- 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 ... management and appeals functions to include coordination of specific process and...+ Ability to utilize critical thinking and apply sound clinical judgment and assessment skills for decision-making. + Knowledge… more
- CVS Health (Sacramento, CA)
- …PST Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more
- CVS Health (Harrisburg, PA)
- …issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from ... outside plan sponsors or regulators. * Research and resolves incoming electronic appeals as appropriate as a "single-point-of-contact" based on type of appeal. *… more
- Centene Corporation (Raleigh, NC)
- …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, ... Must Reside in North Carolina **2+ years of healthcare grievance or appeals , claims, managed care experience, or relevant experience.** **Position Purpose:** Analyze… more
- Nuvance Health (Danbury, CT)
- …5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician ... and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in… more
- University of Michigan (Ann Arbor, MI)
- Clinical Denials Prevention & Appeals Specialist Apply Now **Job Summary** The Clinical Denials Prevention & Appeals Specialist role is entirely remote. ... The Clinical Denials Prevention & Appeals Specialist plays a critical role in optimizing the...their meticulous work + Collaborate with leadership and CDI Coordinator to conduct new-hire training and orientation. **Required Qualifications… 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