- Banner Health (Tucson, AZ)
- …by including remote and hybrid opportunities. In the role of Senior Grievance & Appeals Coordinator , you will utilize your expertise in Grievance & Appeals ... **Primary City/State:** Arizona, Arizona **Department Name:** Grievances & Appeals **Work Shift:** Day **Job Category:** General Operations Great careers are built… more
- Elevance Health (Atlanta, GA)
- **Grievance & Appeals Coordinator ** **Location** : This is a fully remote role. Candidates must reside in the state of **Georgia** to be considered. Ideal ... location in Atlanta, Augusta, Savannah and/or Columbus, GA. The **Grievance & Appeals Coordinator ** is responsible for investigating and reviewing customer… more
- CVS Health (Harrisburg, PA)
- …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
- University of Virginia (Haymarket, VA)
- …minimum loss of revenue and maximum payment for services. Utilizing persuasive clinical arguments and tenacious communication skills, both oral and written, creates ... problem solving methodology to discern trends in payor behaviors and/or our clinical documentation/practice that need to be communicated back to departments or… more
- Commonwealth Care Alliance (Boston, MA)
- …, operations, pharmacy, dental, reporting, and member services. - Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day ... **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department...strict deadlines. - When necessary collaborate with care teams, clinical staff, family members, and other involved in providing… more
- University of Utah (Salt Lake City, UT)
- …PRN40045B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals Coding Specialist SR **Job Grade** E **FLSA Code** Nonexempt **Patient ... or other specialty certification indicated by the department, AND 3 years coding, clinical , or billing experience or equivalency (one year of education can be… 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
- Providence (WA)
- …the best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** + Provide care coordination services ... + This posting is for multiple openings of a Clinical Care Coordinator RN + This position...Management Experience (EX. Concurrent Review, Prior Authorization, Medical Audits, Appeals or Delegation) + Experience working in a health… more
- Providence (OR)
- …the best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** + Support the commercial insurance ... + This posting is for multiple openings of a Clinical Care Coordinator RN + This position...Management Experience (EX. Concurrent Review, Prior Authorization, Medical Audits, Appeals or Delegation) + Experience working in a health… more
- Providence (Beaverton, OR)
- …the best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Maternity / Pediatrics who will:** + Support the ... + This posting is for multiple openings of a Clinical Care Coordinator RN, Maternity / Pediatrics...Management Experience (EX. Concurrent Review, Prior Authorization, Medical Audits, Appeals or Delegation) + Experience working in a health… more
- Rush University Medical Center (Chicago, IL)
- …less than 0.5) **Shift:** **Shift 1** **Work Schedule:** 8 Hr **Summary:** The Clinical resource coordinator (CRC) applies a collaborative approach in working ... disability, veteran status, and other legally protected characteristics.** **Position** Clinical Resource Coordinator Per Diem **Location** US:IL:Chicago **Req… 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
- 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
- Elderwood (Wheatfield, NY)
- Salary Pay: $72,150 - $87,750 / year Overview Sign on bonus for MDS Coordinator $10,000 for full-time (paid over 12 months) What makes Elderwood at Wheatfield ... We want to talk with you! RN - MDS Coordinator Position Overview: + Oversees, reviews and/or completes the...of Benefits Program + Increased Tuition Reimbursement Program for Clinical Tracks + Shift Differentials + Full Benefits Package… more
- CareOregon (Medford, OR)
- …must comply with all federal laws. Job Title Registered Nurse - Care Coordinator (Community) Exemption Status Exempt Department Clinical Services Manager Title ... to achieve optimal health and wellness outcomes. Registered Nurse - Care Coordinator is part of an innovative multi-disciplinary care coordination team addressing… more
- Johns Hopkins University (Baltimore, MD)
- …team supporting the entities that comprise Johns Hopkins Medicine (JHM), including clinical departments, hospitals, satellite clinics, and the School of Medicine. We ... JHM's work to advance medicine and improve the human condition. The Development Coordinator for the Institute for Basic and Behavioral Sciences is an integral member… more
- Elevance Health (Overland Park, KS)
- …to, potential for high-risk complications). + Engages the primary service coordinator and other clinical healthcare management and interdisciplinary teams ... candidates must be located in the state of Kansas.** The **LTSS CONCIERGE COORDINATOR ** is responsible for supporting the LTSS Coordinator (or contracted… more
- State of Colorado (Denver, CO)
- Community Care Coordinator DEHS - FAA02655 Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4714715) Apply Community Care Coordinator DEHS ... the process . + Previous experience working in a pediatric or family medicine clinical setting as a registered nurse or a practice manager, knowledge of clinical… more
- Hackensack Meridian Health (Neptune, NJ)
- …and serve as a leader of positive change. The **Care Management, 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