- Texas Health Resources (Arlington, TX)
- Clinical Reviews , Denial and Appeals RN Bring your passion to THR so we are Better + Together Work location: Remote (Local candidates only) Work hours: ... and effective appeal strategies for medical necessity denials. + Reviews clinical documentation in order to determine...Develops and maintains relationships with other departments related to appeals and denial management. + Serves as… more
- McLaren Health Care (Grand Blanc, MI)
- …communication with related disciplines to address and integrate opportunities for denial appeals . **Essential Functions and Responsibilities as Assigned:** 1. ... of the patient care team. Educates health team colleagues about complex clinical appeals /denials, utilization review, including role, responsibilities tools, and… more
- BronxCare Health System (Bronx, NY)
- …letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... to appeals status, and outcomes by department denial coordinators, physician advisors, and the clinical ...utilize in the formulation of a strong appeal letter. - Reviews all denial notifications in letter and… more
- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals ... Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** * Performs clinical /medical reviews of previously denied cases in which a formal … more
- Nuvance Health (Danbury, CT)
- …inquiries and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and ... Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals ...cases in work queue and incoming fax queue. 10. Reviews denial letters through daily mail and… more
- McLaren Health Care (Mount Pleasant, MI)
- …auditors . Provides support to both internal and external customers for denial / appeals activities and audits. Assists with monitoring and auditing activities, ... outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer… more
- Nuvance Health (Danbury, CT)
- …with appropriate Provider if initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within two hours ... Days, Evenings, Nights available* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient...escalate to the appropriate Provider/VPMA. * Identify and complete clinical reviews required for submission to specific… more
- Mount Sinai Health System (New York, NY)
- …(CCM, ACM) or Utilization Management preferred. + 7+ years of experience in clinical acute clinical , utilization management, appeals management or related ... + Ensure timely and appropriate communication with payers for authorization, denials, and appeals . + Collaborate with physicians and clinical teams to ensure… more
- CVS Health (Sacramento, CA)
- …deviations to determine the accuracy and appropriateness of a benefit/administrative denial . Can review a clinical determination and understand rationale ... may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach...in misrouted work. Assemble all data used in making denial determinations and can act as subject matter expert… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Insurance Appeals Senior , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the ... and training for the financial services staff with regard to clinical and medical necessity insurance denials. Analyzes all correspondence regarding insurance… more