- TEKsystems (San Bernardino, CA)
- Description We are seeking a dedicated Clinical Appeals Nurse to join our Revenue Cycle Management team. The ideal candidate will be responsible for managing ... documentation to support appeals , and following up on submitted appeals . The Clinical Appeals Specialist will work closely with a team of Licensed… more
- Dignity Health (Rancho Cordova, CA)
- **Job Summary and Responsibilities** The Appeals and Grievances LVN is a critical role responsible for managing and resolving all medical necessity appeal ... government entities. This individual acts as a primary liaison for clinical denials, navigating appeal processes through all delegated levels. Key responsibilities… more
- 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...policies and standards **Education/Experience:** RN with 4+ years of clinical nursing and/or case management experience or LPN/ LVN… more
- Integra Partners (Troy, MI)
- …of UM authorization reviews, both verbally and in writing + Process administrative and clinical appeals and refer as needed to the Medical Director + Maintain ... Integra is looking for a LPN/ LVN experienced in the managed care payor environment...environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: LVN /LPT $35.00-44.19 Per Hour RN/LCSW/LMFT/LPCC $54.00-68.18 Per Hour REPORTS TO: ... ensure that extended stays are medically justified. + Payment Appeals : Prepare and submit appeals to third...Treatment Team on a daily basis and collaborate with clinical team to answer clinical questions related… more
- US Tech Solutions (Columbia, SC)
- …management of professional, inpatient or outpatient, facility benefits or services, and appeals . + Documents decisions using indicated protocol sets or clinical ... objectives. Participates in all required training. **Experience:** + 2 years clinical experience. **Skills:** + Working knowledge of word processing software. +… more
- Abbott (Plano, TX)
- …follow up for requested authorizations. + For each procedure, audit required clinical documents for completeness and accuracy. + Obtain authorization for the ... carrier. + Work with key provider contacts to obtain required clinical information for authorizations. + Work with respective carrier'sutilization review department… more