- Elevance Health (Indianapolis, IN)
- …program. + Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with ... **Behavioral Health Medical Director - Psychiatrist - Indiana Medicaid ** **Location:** This role enables associates to work...appeal case reviews with attending physicians or other ordering providers to discuss review determinations. + Serves… more
- CareFirst (Washington, DC)
- …in determination of appropriateness and authorization of inpatient clinical services. Engages onsite with member, family and providers to identify key strategic ... and Northern Virginia area to be part of our Onsite Clinical Navigator team. The Onsite Clinical...(RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely… more
- CareFirst (Baltimore, MD)
- …in determination of appropriateness and authorization of inpatient clinical services. Engages onsite with member, family and providers to identify key strategic ... **Resp & Qualifications** **PURPOSE:** The Onsite Clinical Navigator (RN) embedded at a partnering...(RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely… more
- Conduent (Helena, MT)
- …Career Opportunities, a Great Culture, and Great Benefits!** Interested in supporting Medicaid Providers in Montana? Conduent has immediate openings. This is ... is noticed and valued every day. **This is an onsite position** **No Weekends - Flexible Work Schedule** **Payrate:...a great opportunity to learn about Medicaid Provider support and the medical eligibility and claims… more
- Trinity Health (Gaithersburg, MD)
- **Employment Type:** Full time **Shift:** **Description:** ** ONSITE in Gaithersburg, Maryland - Full Time** **Position Purpose** The Financial Operations Specialist ... Health PACE (TH PACE) programs. This role manages revenue cycles for Medicare, Medicaid , and private pay, oversees expense cycles including vendors and medical … more
- Kaniksu Community Health (Sandpoint, ID)
- …patient demographics, insurance details, and treatment codes (CPT, ICD-10, HCPCS). Review patient accounts and clinical documentation to ensure accurate billing. + ... rejected claims, discrepancies or errors. + Assist in the review of patient refunds and adjustments. + Respond to...including payer policies and HIPAA regulations. + Collaborate with providers , coding staff, and front desk to resolve documentation… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Primary activities include substantiating referrals, case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure ... agencies. Essential Accountabilities: Level I + Functions as a clinical reviewer of medical records, researching and investigating complex medical cases. Interprets… more
- Evolent (Helena, MT)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. ... for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a meaningful impact… more
- Clark County, NV (Las Vegas, NV)
- …Analyst. This position will support the Fiscal, Grants, Contracts, and Medicaid program operations. These supervisory positions provide leadership and oversight in ... critical administrative functions, including fiscal management, Medicaid / Medicaid billing and compliance, grants coordination, and contract administration. The… more
- Evolent (Helena, MT)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. ... Will Be Doing:** . Serve as the Physician match reviewer in Advanced Imaging cases, that do not initially...necessity guidelines, as well as other imaging requests when providers , clients, or state laws require specialty reviews to… more