- 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
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… 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
- McLaren Health Care (Bay City, MI)
- …outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist , or Certified Clinical Documentation Specialist certifications 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
- 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
- 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 (East Syracuse, 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
- CaroMont Health (Gastonia, NC)
- …for promoting and monitoring safe, high-quality, cost-effective healthcare with the best clinical outcomes possible. Provide physician and nurse education to ... and reporting. Perform data collection and analysis, trend identification for assigned clinical outcomes, and present this data at the appropriate meetings as… more
- Kelsey-Seybold Clinic (Houston, 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
- Clark County, NV (Las Vegas, NV)
- FAMILY SERVICES SPECIALIST I/II Print (https://www.governmentjobs.com/careers/clarkcounty/jobs/newprint/4688056) Apply FAMILY SERVICES SPECIALIST I/II Salary ... Selected candidates will be hired at the Family Services Specialist I level and will be required to attend...retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and… 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
- Clark County, NV (Las Vegas, NV)
- …Department is seeking qualified candidates to apply for the Specialty Courts Specialist position. This position provides clinical case management duties ... SPECIALTY COURTS SPECIALIST Print (https://www.governmentjobs.com/careers/clarkcounty/jobs/newprint/4701322) Apply SPECIALTY COURTS SPECIALIST Salary $32.74 -… more
- Intermountain Health (Logan, UT)
- **Job Description:** The Adult Behavioral Health Specialist (BHS), under the direction and supervision of the treatment team, provides direct therapeutic contact to ... to self and others. **Scope:** The Adult Behavioral Health Specialist provides care to patients in accordance with the...in delivering core group content as outlined by licensed clinical staff through skill building and psycho educational groups.… more
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