- HCA Healthcare (Nashville, TN)
- …patients with purpose and integrity. We care like family! Jump-start your career as a Clinical Appeals Team Lead Nurse today with Parallon. **Benefits** ... for benefits may vary by location._** Come join our team as a Clinical Appeals Team Lead Nurse. We care for our community! Just last year, HCA… more
- Diversicare Healthcare Services & Diversicare Ther (Brentwood, TN)
- …required** Are you passionate about caregiving? Would you like to work with the best team in the world? If so, Diversicare invites you to apply. We build on trust, ... skills to shape the culture in our workplace. Diversicare team members play a critical role in fostering an...Service Standards are in place to offer support. They lead us to what matters most to our company:… more
- LifePoint Health (Brentwood, TN)
- …hospital leadership. This position also provides oversight to the DRG Downgrade Appeals Specialist team . *Responsibilities:* . Oversee the operations and human ... to maintain and improve KPIs. . Develop and execute appeals management strategies for the DRG downgrade team...within the medical record and evidence-based literature. . Ensure appeals follow current industry clinical guidelines, evidence… more
- Humana (Nashville, TN)
- …resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
- Humana (Nashville, TN)
- …resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal… more
- The Cigna Group (Franklin, TN)
- …the programs. **Responsibilities and Essential Functions** + Responsible for development of clinical policy, clinical review decisions, appeals , audits, and ... program development, clinical criteria, and provider issues, supported by program clinical leaders + Collaborate with the Analytics team to provide… more
- Humana (Nashville, TN)
- …and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, ... reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services.… more
- Humana (Nashville, TN)
- …some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and clinical leadership. After ... is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical ...performed with minimal direction, but with support from other team members. The Medical Director enjoys working in a… more
- Elevance Health (Nashville, TN)
- …those member's cases (serving as the single point of contact) with the clinical healthcare management and interdisciplinary team in order to provide care ... + Uses tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for… more