- Northwell Health (Melville, NY)
- …stay. Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… 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
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for all lines...case reviews, and prepares final case submissions. + Refers clinical appeal cases to Medical Nurse Auditors… more
- City and County of San Francisco (San Francisco, CA)
- …and assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist (Critical Care) performs other related duties ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... + Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending. + Coordinates RAC … more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization Specialist is responsible for managing...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- MaineGeneral Health (Waterville, ME)
- …patients and their families. MaineGeneral Hospice is currently seeking an experienced Registered Nurse (RN) for a 32-40 hour per week position. The Hospice Quality ... Specialist ensures that patient care services are delivered in...as a consultant/mentor for staff in areas of documentation, clinical practice and professional development. + Develops, implements and… more
- Point32Health (MA)
- …are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Training Specialist is responsible for the development, ... implementation, and execution of a wide range of clinical , regulatory and operational training programs, including orientation and annual competency. This individual… 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
- State of Colorado (CO)
- …CAA Nurse III 01/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 12/17/2024 Closing Date 6/30/2025 4:00 PM ... CDOC Nurse Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4764859) 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/4762850) Apply CDOC Registered Nurse ( Nurse I) ... $7,442.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 01/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (Sterling, CO)
- CDOC Registered Nurse - Part-time - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4756062) Apply CDOC Registered Nurse - ... Salary $3,721.00 Monthly Location Sterling, CO Job Type Part Time Job Number CAA Nurse I SCF 012/2024 Department Department of Corrections Division Clinical and… more
- City and County of San Francisco (San Francisco, CA)
- …Under general direction, the Emergency Medical Services Agency (EMSA) Specialist oversees, plans, and monitors EMS System programs, trainings, standards ... Minimum Qualifications Experience: Three (3) years of field or clinical experience as an Emergency Medical Technician-Paramedic (EMT-P), Registered … more
- State of Colorado (Limon, CO)
- CDOC Licensed Practical Nurse (LPN) -- Limon Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4748844) Apply CDOC Licensed Practical Nurse ... treatment plans, employs infection control measures, provides referral to appropriate Clinical Services staff for new arrivals, crisis intervention, interviews and… more
- Indian Health Service (Rosebud, SD)
- …in a timely and efficient manner. Works closely with credentialing, Staff Development Specialist , and Nurse Educator to enroll nursing and providers with South ... will include; 1) Prior Authorizations/Pre-Certifications; 2) Provider Enrollment; 3) Appeals ; and 4) Accounts Receivable. Responsibilities Works closely with the… more
- State of Colorado (Canon City, 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 (CO)
- …Job Number CAA Physician 01/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 12/18/2024 Closing Date 6/30/2025 4:00 ... on-call assessment, diagnosis, and treatment of inmates in one or more prison clinical settings. Physicians are responsible for, but not limited to, the following: +… more
- State of Colorado (Denver, CO)
- …Den 14021 Pharm Tech 01/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 12/30/2024 Closing Date 1/14/2025 4:00 ... and more. Description of Job This position assists the clinical services staff to optimize medication management within a...to the proper destinations under the supervision of a Nurse III; + Assist with prescription and medication inventory… more
- Centene Corporation (Tallahassee, FL)
- …to audit errors + Coordinate auditing outcomes and system maintenance with the Sr. + Clinical Systems Specialist to resolve or enhance clinical systems + ... the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes + Develop and maintain the audit process and… more
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