- Premier Health (Dayton, OH)
- …related experience Prior job title or occupational experience: Case management, Utilization review Prior specific functional responsibilities: N/A Preferred ... contracts, Medicare and Medicaid guidelines, and other regulations which impact the utilization or denial of provider services. Essential Duties & Functions:… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Claim and Denial Coding Analyst role is a Certified Medical Coder who ensures clean claim ... after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications. The appeals process may include collaboration… more
- CaroMont Health (Gastonia, NC)
- …of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal results. ... practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum… more
- The Cigna Group (Bloomfield, CT)
- …preferred + 5+ years of experience is preferred in prior authorization or utilization review and appeals + Demonstrated proficiency with Microsoft Office ... Nurse Case Management Lead Analyst -Nurse Clinician - Accredo Job Description Summary The...years of experience is preferred in prior authorization or utilization review and appeals + Demonstrated proficiency… more
- The County of Los Angeles (Los Angeles, CA)
- …and students in the allied health fields. Instructs community agencies regarding the utilization of mental health principles to identify and to treat mental health ... mental health problems and to improve therapeutic treatment methods. May review treatment authorization requests from hospitals, contracted network and/or legal… more