- BroadPath Healthcare Solutions (Tucson, AZ)
- …seeking a highly motivated and results-driven **UM RN Appeals Coordinator .** This role collaborates with clinical review staff, medical directors/physician ... reviewers, network physicians, and network facilities to ensure consistent clinical evaluation and processing of medical necessity appeals . Accurate… 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 with State and NCQA standards. + Maintain files and logs for all appeals +… more
- Community Health Systems (Franklin, TN)
- …reduce future denials, and ensure compliance with payer guidelines. As a Denial Appeals Coordinator at Community Health Systems (CHS) - PCCM, you'll play ... **Job Summary** The Denial Coordinator is responsible for reviewing, tracking, and resolving...reviewing, tracking, and resolving denied claims, ensuring that appropriate appeals are submitted, and working closely with payers, internal… more
- Centene Corporation (Harrisburg, PA)
- …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, ... Purpose:** **Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.**… more
- CVS Health (Austin, TX)
- …issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from ... outside plan sponsors or regulators. + Research and resolves incoming electronic appeals as appropriate as a "single-point-of-contact" based on type of appeal. +… more
- Nuvance Health (Danbury, CT)
- …5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician ... and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in… more
- State of Colorado (Golden, CO)
- Medical Operations Coordinator (Nurse V) - Lookout Mountain Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5166280) Apply ... Medical Operations Coordinator (Nurse V) - Lookout Mountain Youth Services Center...level supervisor, contributes to the evaluation of medical and clinical performance of all DYS medical staff as needed,… more
- Elderwood (Waverly, NY)
- …handles Third Party appeals , peer to peers as applicable and with clinical oversight provided by the LPN/RN MDS Coordinator . Attends team meetings at ... Salary $ 20 / $ 22 Overview Managed Care Coordinator Overview Mon-Fri 8am-4pm The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator … more
- Community Health Systems (Antioch, TN)
- **Job Summary** The Denial Coordinator is responsible for reviewing, tracking, and resolving denied claims, ensuring that appropriate appeals are submitted, and ... Hyland, BARRT, and other host systems, ensuring timely follow-up on denials and appeals . + Conducts follow-up calls and payer portal research to track the status… more
- Adelphi University (Garden City, NY)
- …liaison ensuring that candidates experience continuity and support across academic and clinical settings. The Coordinator monitors Manhattan Center RSA CEHS ... NYC Education Program Coordinator Job Department/School College of Education and Health...Teacher Examination and Workshop dates and deadlines. + Oversee clinical practice supervision to ensure candidates receive ongoing support… more
- HCA Healthcare (Manchester, NH)
- …care like family! Jump-start your career as a Medical Staff Services Coordinator today with Catholic Medical Center. **Benefits** Catholic Medical Center, offers a ... Come join our team as a Medical Staff Services Coordinator . We care for our community! Just last year,...play a key role in the integration of HCA Clinical Strategies and HCA systems. 1. Medical Staff Administration… more
- Sharp HealthCare (San Diego, CA)
- …and employer business practices. **What You Will Do** The Transplant Financial Coordinator plays an integral role in assisting patients with the critical function ... billing compliance. The primary responsibility of the Transplant Financial Coordinator is assessing patient's insurance coverage and financial situation for… more
- Cedars-Sinai (Beverly Hills, CA)
- …innovation. **A Little More About What You Will be Doing** The RN Care Coordinator is responsible for the case management of patient while hospitalized and upon ... In collaboration with the Inpatient Specialty Program (ISP) hospitalists, the RN Care Coordinator will assist patients from the time they are admitted until they are… 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
- US Tech Solutions (RI)
- …with other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). + Identify and elevate clinical inquiries to the ... + Maintains complete, timely and accurate documentation of reviews. + Transfers all clinical questions, escalations and judgement calls to the pharmacist team. + The… more
- Elevance Health (Cape Coral, FL)
- **LTSS Service Coordinator ** **Location** _:_ This is primarily a field based position. Candidate would need to reside in one of the following counties: **Collier, ... by law._ **Schedule** _:_ Monday-Friday 8am-5pm EST The **LTSS Service Coordinator ** is responsible for conducting service coordination functions for a defined… more
- Elevance Health (OH)
- **LTSS Service Coordinator (Case Manager)** **Candidates should live in one of the following counties:** Auglaize, Coshocton, Defiance, Gallia, Harrison, Holmes, ... long term services and supports, and psychosocial needs. The **LTSS Service Coordinator ** is responsible for managing service coordination for a designated caseload… more
- Elevance Health (Viroqua, WI)
- **LTSS Service Coordinator (Case Manager)** **$5,000 Sign-on Bonus** **Hiring near Southwestern Wisconsin in counties:** Pepin, Buffalo, Trempealeau, Jackson, Clark, ... living, employment, and contributing to their communities. The **LTSS Service Coordinator ** is responsible for conducting service coordination functions for a… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals ... activities. This role collaborates with payers, hospital staff, and clinical specialists to secure timely authorizations for hospital admissions and extended stays.… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non- clinical tasks related to processing ... Utilization Management prior authorization sand appeals . JOB RESPONSIBILITIES + Monitor incoming faxes + Enter...expected timelines EXPERIENCE: + 1 year as a UM Coordinator in a managed care payer environment preferred +… more
