- 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
- Molina Healthcare (Georgetown, KY)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...more of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist … more
- St. Mary's Healthcare (Amsterdam, NY)
- …based on experience and other factors permitted by law. Responsibilities: * Uses clinical and coding knowledge to ensure accurate and compliant charge items and to ... and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review… more
- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... resource in outpatient clinical documentation review to establish and manage clinical and prior authorization denial appeals for the Carle enterprise.… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and ... expedited and external case reviews, and prepares final case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy Technicians for… more
- State of Indiana (Indianapolis, IN)
- Public Health Nurse Specialist Date Posted: Sep 5, 2024 Requisition ID: 449097 Location: Indianapolis, IN, US, 46202 Work for Indiana Begin a fulfilling career ... regardless of where they live, learn, work, or play. Role Overview: As a Nurse Specialist you will determine medical eligibility of applicants and provide prior… more
- BrightSpring Health Services (Louisville, KY)
- …be met. This position will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address identified trends in reasons ... Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors,...processing of all episodes of care. Reviews documentation for appeals processes across the Home Health enterprise for all… 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
- Centene Corporation (Brooklyn, NY)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... term care services + Assist member with filing and resolving complaints and appeals + Direct care to participating network providers + Participate in care management… more
- Centene Corporation (Brooklyn, NY)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... term care services + Assist member with filing and resolving complaints and appeals + Direct care to participating network providers + Participate in care management… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …a liaison to the Grievance and Appeals Department for Medicare Advantage appeals . The Utilization Review Specialist (LVN) is responsible for completion and ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to determine… 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/4646255) Apply CDOC Registered Nurse - ... Denver, CO Job Type Part Time Job Number CAA Nurse I 8212 09/2024 Department Department of Corrections Division... I 8212 09/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 09/05/2024 Closing Date… more
- State of Colorado (Sterling, CO)
- CDOC Licensed Practical Nurse -- Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4600127) 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
- Sanford Health (Thief River Falls, MN)
- …clinical or business processes. Responsible for reviewing medical records and preparing clinical appeals , as appropriate, on medical necessity, level of care, ... join our Behavioral Health team as a Utilization Review Specialist utilizing a team-based approach to patient care in...Nurse (RN) preferred. Five years' experience in a clinical setting required. Preference given to individuals with experience… 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 ... night, grave and weekend shifts!** **Scope:** The Pediatric Behavioral Health Specialist provides care to patients in accordance with the established… more
- HCA Healthcare (Nashville, TN)
- …reach our goals. Unlock your potential! **Job Summary and Qualifications** The Clinical Review Specialist is responsible for performing retrospective medical ... required + Successful completion of an accredited Licensed Practical/Vocational Nurse Program + A minimum of one-year experience reviewing...+ A minimum of one-year experience with denials and appeals in a clinical setting preferred +… more
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