- WellSpan Health (York, PA)
- …Committee. + Works closely with Medical Director to identify trends in payor denials and appeals . + Serves as point of contact for System acute care ... Director -Utilization and Denials Management Location: WellSpan...Oversees the utilization management process for preauthorization, concurrent review, denials and appeals for System acute care… more
- HCA Healthcare (Nashville, TN)
- …our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Appeals Team Lead with Parallon you can be a part of an ... in our organization. We are looking for an enthusiastic Clinical Appeals Team Lead to help us...The Compliance Nurse Team Lead is responsible for providing clinical input or interpretation for denials that… more
- University of Utah (Salt Lake City, UT)
- …+ Demonstrated knowledge of revenue cycle. + Working knowledge of insurance denials , appeals and expected reimbursement rates. + Experience presenting findings ... PRN39530B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals Coding Specialist SR **Job Grade** E **FLSA Code** Nonexempt **Patient… more
- HonorHealth (Phoenix, AZ)
- …stakeholders to identify revenue leakage, monitor charge capture activities, oversee payer clinical denials and audits, ensure optimal clean claim rates, and ... clinical charge capture accountability, documentation improvement, and payer appeals . By creating collaborative, high performing work environments, optimizing… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... Claims and Customer Service, to provide guidance on complex Authorizations, Referrals, Denials and Appeals . + Integrates and coordinates services using… more
- Brockton Hospital (Brockton, MA)
- …external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the ... PURPOSE OF POSITION: The Director of Case Management is responsible for planning,...the development and supervision of staff (RNs, LPN's,SWs and non- clinical support), evaluation and maintenance of case management skills… more
- AdventHealth (Maitland, FL)
- …**The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members of the Case ... prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician review of utilization, claims management,… more
- The Mount Sinai Health System (New York, NY)
- …Shares denial data with physicians and collaborates on strategies to reduce denials . Works collaboratively with the Medical Centers Appeals Management Program. ... **JOB DESCRIPTION** The Director of Case Management is responsible for the...engage internal and external stakeholders in the improvement of clinical case management, outcomes management processes and throughput. **RESPONSIBILITIES**… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** **Job Title: Executive Director - Social Services - MSH - Full Time - Day** The Executive Director of MSH Social Work provides financial, ... programs, strategies and initiatives designed to develop, enhance and support the clinical , research and educational goals for the department(s). The Executive … more
- UPMC (Moosic, PA)
- …interests, we invite you to learn more and apply today! The Senior Medical Director provides guidance for clinical operational aspects of the program, including ... have an exciting opportunity for a full-time Senior Medical Director to join our leadership team with UPMC Community...Community Care was created by a leadership team whose clinical experiences as behavioral health providers compelled them to… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …standardized criteria to determine medical necessity; reviews and processes concurrent denials that require medical necessity determinations; processes appeals ... leaders who care about your success. The Utilization Management (UM) Director is responsible for the market(s) development, implementation, evaluation and direction… more
- CVS Health (Columbus, OH)
- …concurrent and prior authorization reviews with peer to peer coverage of denials . * Appeals - The medical director will perform appeals in their "base ... to its membership. Aetna is looking for a medical director to be part of a centralized team that...lead daily rounds. **Required Qualifications:** Minimum 3-5 years of clinical practice experience. Two (2) + years of experience… more
- Nuvance Health (Danbury, CT)
- …for denials identification and remediation of root causes, submit appeals , funnel education back to responsible parties, and track success towards future ... care. Non-acute care is offered through various affiliates, *Summary:* The Director of Financial Clearance is responsible for daily operations and functions… more
- UNC Health Care (Chapel Hill, NC)
- …role is responsible for the daily operations of the Utilization Management and Clinical Denials Management functions of the department as well as collaborating ... and skills as we approach complex payor communications and appeals work. This position is fully onsite at the...hospital campus functions. Summary: Responsible for assisting the Regional Director of Clinical Care Management in overall… more
- Sharecare, Inc. (Columbus, OH)
- …or assist member in working with payer to complete prior authorization or appeals process, when necessary. + Abide by Clinical Advocacy Program Description ... benefit coverage, explanation of benefits, and reasons for coverage denials . + Ensure all health care services are medically...+ Direct questions from providers or members to the Clinical Advocate Manager or Director when he/she… more
- Nuvance Health (Danbury, CT)
- *Description* Summary: Identifies and communicates the clinical denials in a timely manner in collaborationand working closely with the physical advisors, ... Clinical Denial Specialist nurses, Case managers, Case Management Operation...a timely manner. 5. Creates a weekly assignment for director to review for appeals . 6. Communicates… more
- HCA Healthcare (El Paso, TX)
- …verified denials and cooperates with denials management to provide additional clinical information for appeals . + You will educate patient and family on ... by location._** HCA Healthcare is committed to research and clinical protocols. Do you want to impact standards of...is unavailable. + You will proactively initiate an expedited appeals process with payers and communicates with denials… more
- Billings Clinic (Billings, MT)
- …and/or continued stay Proactively interacts with payers and proactively sends clinical reviews to prevent inpatient denials Proactively communicates with ... is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team for optimal/efficient… more
- WMCHealth (Valhalla, NY)
- …in daily review of aggregate denials / appeals with the Medical Director , peer, or the Clinical Review Supervisor. + Provides continuous education to ... within the regulatory timeframe of the request. + Provides clinical rational for standard and expedited appeals ....and/or complete appeals as required to overturn denials . + Provides assistance to initial clinical … more
- HCA Healthcare (Sarasota, FL)
- …medical consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials process, discharge ... Officer (CMO) ensures high quality, patient-centered care by leading clinical and quality initiatives that support the provision of...managers and hospital staff in the reduction of payer denials and in the denial and appeals … more