- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist ...and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse … more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal ... of clinical nursing and medical practices, the Clinical Appeals Specialist will review...review, and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse Practitioner, with… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California, Active BLS -… more
- MetroHealth (Cleveland, OH)
- …and experience in addition to experience noted below. Minimum of 5 years as Clinical Documentation Integrity Specialist or; - CDIP or CCDS Certification with ... departments and more than 20 health centers.** **Summary:** **Performs secondary clinical chart reviews, resolves DRG discrepancies, and educates clinical … more
- Tarrytown Rehabilitation & Nursing Center (Everett, MA)
- CLINICAL REIMBURSEMENT SPECIALIST / MULTI FACILITY We offer competitive compensation and benefit plans including: + Competitive Pay + Medical, Dental, Vision ... Family-Like Team, and Atmosphere! We are seeking an experienced Clinical Reimbursement Specialist to support our MDS/MMQ...and MMQ vacancies. Qualifications: + Licensed as a Registered Nurse in the State of Massachusetts + Three to… more
- Trinity Health (Des Moines, IA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The purpose of the Clinical Integration Specialist is to assist and support the Director in ... requirements that improve outcomes and reduce harm to patients. The specialist works closely with ministry colleagues, providers, and leaders in implementing,… more
- Insight Global (Skokie, IL)
- Job Description Insight Global is looking for a clinical denials specialist to join the team at one of your healthcare clients in Chicago. As a Clinical ... perspective. This person will be responsible for preparing appeals and communication with the clinical team...and Requirements 3+ years experience as a utilization review nurse Experience reviewing and analyzing denied claims Knowledge of… more
- AdventHealth (Altamonte Springs, FL)
- …denial root cause and bring about the best opportunity for fair reimbursement. The Clinical Denial Management Specialist will adhere to the AHS Compliance Plan ... obtain further patient information to be used in the appeals process if necessary. . Provide reports, education, and.... Minimum of three (3) years' experience as Registered Nurse (RN) in an acute clinical setting… more
- Cleveland Clinic (Vero Beach, FL)
- …information to the payer, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser interaction and ... stay or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review, providing clinical information to payers,… more
- State of Colorado (CO)
- …CAA Nurse III 2/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 02/08/2024 Closing Date 12/31/2024 4:00 PM ... CDOC Nurse Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4383689) Apply CDOC Nurse Supervisor Salary $8,204.00 - $11,487.00… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4555045) Apply CDOC Registered Nurse ( Nurse I) ... $7,442.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 7/2024 Department Department of Corrections Division Clinical and… more
- State of Colorado (Denver, CO)
- CDOC Registered Nurse - Part-time - Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4737141) Apply CDOC Registered Nurse - ... Denver, CO Job Type Part Time Job Number CAA Nurse I 8212 11/2024 Department Department of Corrections Division... I 8212 11/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 11/20/2024 Closing Date… more
- Office of Personnel Management (Washington, DC)
- …outside sources, including the health benefits Plan and providers. Consult with internal clinical advisors (eg nurse ) to resolve disputed health benefits claims ... Summary As a Legal Administrative Specialist (Insurance Benefits Claims Examiner), you will be...Federal enrollees and/or their authorized representatives, including responses on appeals of disputed health benefit claims, benefits regulations, and… more
- Office of Personnel Management (Washington, DC)
- …outside sources, including the health benefits Plan and providers. Consult with internal clinical advisors (eg nurse ) to resolve disputed health benefits claims ... Summary As a Legal Administrative Specialist (Insurance Benefits Claims Examiner), you will be...Federal enrollees and/or their authorized representatives, including responses on appeals of disputed health benefit claims, benefits regulations, and… more
- Intermountain Health (Salt Lake City, UT)
- **Job Description:** The Pediatric Behavioral Health Specialist (BHS), under the direction and supervision of the treatment team, provides direct therapeutic contact ... risk to self and others. **Scope:** The Pediatric Behavioral Health Specialist provides care to patients in accordance with the established multi-disciplinary… more
- State of Colorado (Denver, CO)
- …Information Colorado Department of Corrections Mission: $25,000 HIRING INCENTIVE FOR FULL-TIME CLINICAL PROFESSIONALS! If your goal is to build a career that makes ... acute, chronic, and emergency care for inmates in the clinical setting, which could include a clinic, an infirmary,...must possess current, valid licensure as an Advanced Practice Nurse / Nurse Practitioner from the Colorado… more
- State of Colorado (Canon City, CO)
- …diagnosis, and treatment for acute, chronic, and emergency care for inmates in the clinical setting, which could include a clinic, an infirmary, or a special needs ... and other related laboratory tests; + Follow the CDOC clinical services standards and procedures, protocols, guidelines, or policies...must possess current, valid licensure as an Advanced Practice Nurse / Nurse Practitioner from the Colorado… more
- State of Colorado (Pueblo, CO)
- …position is responsible for, but not limited to, the following: + In a clinical setting, assist patients with activities of daily living to include bathing, mouth ... Obtains and records vital signs for review by staff nurse ; + Provide and assist with patient transfers and...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- …duties. This position works under the supervision and direction of a registered nurse and assists with psychiatric nursing care of mentally ill patients; observes, ... Patient Care: + Under the direction and supervision of a registered nurse , engage with patients to establish and maintain a therapeutic relationship which… more
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