- Accounting Now (Tampa, FL)
- The Denials Specialist performs advanced-level work related to clinical and coding denial management and appeals follow-upThe individual is responsible for ... and appeal processes and escalates timely filing requests to LeadershipCollaborates with Clinical Denials Nurse , Coding Denials Specialists, and Leadership in… more
- Compass Health Network (Arnold, MO)
- …behavior to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are ... a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff...taken care of. An Outpatient Nurse will have a Monday through Friday schedule with… more
- Compass Health Network (Raymore, MO)
- …behavior to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are ... a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff...taken care of. An Outpatient Nurse will have a Monday through Friday schedule with… more
- Compass Health Network (Jefferson City, MO)
- …behavior to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are ... a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff...taken care of. An Outpatient Nurse will have a Monday through Friday schedule with… more
- Compass Health Network (St. Charles, MO)
- …behavior to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are ... a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff...of Microsoft Office Suite preferred LICENSURE/CERTIFICATION If Licensed Practical Nurse , license issued in Missouri required. LPN, RN or… more
- Compass Health Network (St. Charles, MO)
- …behavior to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are ... will interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion"… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse … more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal ... of clinical nursing and medical practices, the Clinical Appeals Specialist will review...review, and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse Practitioner, with… more
- Molina Healthcare (Georgetown, KY)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...more of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist … more
- St. Mary's Healthcare (Amsterdam, NY)
- …based on experience and other factors permitted by law. Responsibilities: * Uses clinical and coding knowledge to ensure accurate and compliant charge items and to ... and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review… more
- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... resource in outpatient clinical documentation review to establish and manage clinical and prior authorization denial appeals for the Carle enterprise.… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve medically… more
- State of Indiana (Indianapolis, IN)
- Public Health Nurse Specialist Date Posted: Sep 5, 2024 Requisition ID: 449097 Location: Indianapolis, IN, US, 46202 Work for Indiana Begin a fulfilling career ... regardless of where they live, learn, work, or play. Role Overview: As a Nurse Specialist you will determine medical eligibility of applicants and provide prior… more
- BrightSpring Health Services (Louisville, KY)
- …be met. This position will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address identified trends in reasons ... Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors,...processing of all episodes of care. Reviews documentation for appeals processes across the Home Health enterprise for all… more
- Tarrytown Rehabilitation & Nursing Center (Everett, MA)
- CLINICAL REIMBURSEMENT SPECIALIST / MULTI FACILITY We offer competitive compensation and benefit plans including: + Competitive Pay + Medical, Dental, Vision ... Family-Like Team, and Atmosphere! We are seeking an experienced Clinical Reimbursement Specialist to support our MDS/MMQ...and MMQ vacancies. Qualifications: + Licensed as a Registered Nurse in the State of Massachusetts + Three to… more
- Trinity Health (Des Moines, IA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The purpose of the Clinical Integration Specialist is to assist and support the Director in ... requirements that improve outcomes and reduce harm to patients. The specialist works closely with ministry colleagues, providers, and leaders in implementing,… more
- Centene Corporation (Brooklyn, NY)
- …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, ... term care services + Assist member with filing and resolving complaints and appeals + Direct care to participating network providers + Participate in care management… more
- Centene Corporation (East Syracuse, NY)
- …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, ... term care services + Assist member with filing and resolving complaints and appeals + Direct care to participating network providers + Participate in care management… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …a liaison to the Grievance and Appeals Department for Medicare Advantage appeals . The Utilization Review Specialist (LVN) is responsible for completion and ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to determine… more
- State of Colorado (CO)
- …CAA Nurse III 2/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 02/08/2024 Closing Date 12/31/2024 4:00 PM ... CDOC Nurse Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4383689) Apply CDOC Nurse Supervisor Salary $8,204.00 - $11,487.00… more
