- Kelsey-Seybold Clinic (Pearland, TX)
- …to meet both Corporate and CMS regulatory standards. **Job Title: Appeals & Grievances Coordinator ** **Location: Pearland Administrative Office** **Department:** ... This role actively manages all Medicare reconsiderations, grievances, and appeals , adhering to company policies and CMS regulatory requirements. As… more
- Centene Corporation (Oklahoma City, OK)
- …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, ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- UNC Health Care (Goldsboro, NC)
- …the Physician Advisors and subject matter experts for all audit and appeals work activities. Responsibilities: 1. Provides leadership, clinical expertise and ... denials for validity and probability to overturn, proactively gathers required clinical documentation and formulates appropriate appeals . Coordinates the denial… more
- Medical Mutual of Ohio (OH)
- …D experience is highly sought after._** **Responsibilities** **Medicare Pharmacy Coordinator I** Working under general supervision, administers standardized to ... outbound calls to members, providers, and pharmacies to initiate coverage determinations/ appeals , prescription refills, and switch members to lower cost therapeutic… more
- Squirrel Hill Health Center (Pittsburgh, PA)
- …Health Center (SHHC), is a Federally Qualified Health Center (FQHC), seeking a dedicated Clinical Support Coordinator to join our team. The ideal candidate ... insurance companies to streamline the authorization process. The Clinical Support Coordinator will assist SHHC Providers...of approval or denial statuses, including next steps for appeals if necessary. + Documentation: + Accurately… more
- CVS Health (Charleston, WV)
- …affordable. **Position Summary** Responsible for intake, investigation and resolution of appeals , complaints and grievances scenarios for all products, which may ... responses from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance. Identify trends and emerging issues and report… more
- State of Colorado (Denver, CO)
- Youth Corrections Medical Operations Coordinator (Nurse V) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4573875) Apply Youth Corrections ... Medical Operations Coordinator (Nurse V) Salary $108,540.00 - $151,968.00 Annually Location...clinic operations + Respond to case escalations + Provide clinical coverage as needed + Review and approve the… more
- University of Colorado (Aurora, CO)
- **Director of Investigations and Deputy Title IX Coordinator ** **Description** **University of Colorado Denver | Anschutz Medical Campus** **Department:** **Office ... of Equity** **Job Title:** **Director of Investigations and Deputy Title IX Coordinator ** **Position #:** **00746937 - Requisition #: 35898** **Job Summary:** as… more
- University of Colorado (Denver, CO)
- **Senior Coordinator for Housing and Dining 3 Vacancies / Openings** **University of Colorado Denver** Senior Coordinator for Housing and Dining [3 Vacancies / ... **Official Title: Student Services Senior Professional** **Working Title: Senior Coordinator for Housing and Dining [3 vacancies]** **FTE: Full-time** **Salary… more
- Centene Corporation (Olympia, WA)
- …with customer expectations and lead clinical quality initiatives. Review clinical information for appeals to determine medical necessity of services, ... + Lead Behavioral Health Performance Improvement Projects (PIPS) + Review clinical information for appeals to determine medical necessity + Prepare cases for … more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Case Management (CM) Coordinator position is a proficient CM representative that provides technical, clerical and data management support ... and other community resources and transportation. In addition, the CM Coordinator position anticipates independent actions necessary to provide competent and… more
- Baptist Memorial (Memphis, TN)
- Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support billing compliance and external regulatory requirements. ... Responsibilities + Abstracts pertinent information from the medical record to create appeals for cases denied by governmental payors. + Educates department staff to… more
- ProMedica Health System (Sylvania, OH)
- The Transition Coordinator is responsible for managing referrals and coordinating admissions for the transition of patients to and from the Flower Rehab Center. This ... internal and external physicians, nursing, therapists, leadership, coding and clinical documentation specialists, patients, caregivers, and the community. This role… more
- Hackensack Meridian Health (Neptune, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator , Utilization Management** is a member of the healthcare team and is responsible ... for coordinating, communicating, and facilitating the clinical progression of the patient's treatment. Accountable for a designated patient caseload; the Care … more
- Hackensack Meridian Health (Holmdel, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator , Utilization Management** is a member of the healthcare team and is responsible ... for coordinating, communicating, and facilitating the clinical progression of the patient's treatment. Accountable for a designated patient caseload; the Care … more
- Sacramento County (Sacramento, CA)
- Treatment Center Program Coordinator Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1180508) Apply Treatment Center Program Coordinator ... management with emphasis on health occupations + Principles and techniques of clinical interviewing, diagnosis, and treatment + Most current version of the Diagnosis… more
- ProMedica Health System (Toledo, OH)
- …Ohio to receive this honor. POSITION SUMMARY The Care Navigation Resource Coordinator works directly with unit RN Acute Care Navigator(s) and Social Worker(s) ... and reports to the Manager of Care Navigation. The Care Navigation Resource Coordinator provides assistance and support to the care navigation team to assist with… more
- Elevance Health (Tyler, TX)
- **LTSS Service Coordinator ** _Location:_ This is a field based position. Candidate would need to meet face to face with patients in and around the following ... + Nueces County + Tyler + Jefferson + Victoria The **LTSS Service Coordinator ** is responsible for conducting service coordination functions for a defined caseload… more
- UPMC (Erie, PA)
- …Western Behavioral Health at Safe Harbor is seeking a passionate **Service Coordinator Supervisor** to lead a new initiative focused on providing case management ... To address the growing complexity of housing instability, the **Service Coordinator Supervisor** will follow the Cultivating Health for Success (CHFS) model.… more
- Mohawk Valley Health System (Utica, NY)
- Registered Nurse - MDS Coordinator - Per Diem - Days Department: UTILIZATION SERVICES Job Summary The RN - MDS Coordinator will play a crucial role in ensuring ... Medicare documentation and Medicare (re)certifications. + Initiates and monitors appeals to Livanta. + Prepares CMI (Case Mix Index)...Requirements REQUIRED: + Three (3) or more years of clinical experience in an acute or long term care… more