- Adecco US, Inc. (Minneapolis, MN)
- Adecco Healthcare & Life Sciences is hiring a **remote Clinical Appeals Reviewers** ! This role is remote but may need to go to the office in Ontario, CA from ... time to time. Please read below and apply with an updated resume for consideration: **Type:** Three-month contract, opportunity for extension or full-time offer **Schedule:** Monday through Friday, 8AM to 4:30PM **Pay:** $24 to $26.30an hour… more
- Evolent (St. Paul, MN)
- …processed appeals . **Qualifications Required and Preferred** : + 1-3 years' experience in clinical Appeals Review and is an LPN - Required and Preferred. ... and client policies and procedures while complying with timeliness guidelines. Our clinical nurse reviewer team values collaboration, continuous learning, and a… more
- Adecco US, Inc. (Minneapolis, MN)
- …local time **Pay:** $51.50 to $53.95 an hour **Responsibilities of the Appeals Pharmacist:** . Interpret physicians' prescriptions and clinical documentation, ... patients and/or physicians regarding use of medications, potential drug interactions, and clinical status for appeals requests . Conduct Quality Assurance and… more
- Evolent (St. Paul, MN)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/ clinical review guidelines and parameters to assure ... the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer you will be a key...consistency in the MD review process to reflect appropriate utilization and compliance with… more
- CVS Health (St. Paul, MN)
- …system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. **This is a ... As a Medical Director you will focus primarily on review appeal cases for denied medical services. This includes...cases for denied medical services. This includes First Level Appeals / Second Level Appeals / Expedited… more
- Humana (St. Paul, MN)
- …this knowledge in their daily work The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review ... resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and… more
- Humana (St. Paul, MN)
- …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of ... resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and… more
- Humana (St. Paul, MN)
- …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid… more
- Highmark Health (St. Paul, MN)
- …of the rates; prepares and presents first and second level medical underwriting appeals and applicable clinical records to physician advisors; and analyzes high ... if applicable, completes referral requests for case/care management or provider review . The incumbent must communicate effectively with various internal departments… more
- Evolent (St. Paul, MN)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... Will Be Doing:** + Serve as the specialty match reviewer in Cardiology cases, that do not initially meet...be completed by the subject matter expert. + Provides clinical rationale for standard and expedited appeals .… more
- Fairview Health Services (St. Paul, MN)
- …is responsible for the completion of admission and continued stay clinical review , including obtaining insurance certification/authorization necessary to secure ... Expectations:** + Perform and document timely and accurate utilization management review to ensure compliance with all policies, procedures, regulatory and… more
- Cardinal Health (St. Paul, MN)
- …and healthcare providers, as well as assist with any prior authorizations or appeals to facilitate coverage and dispense of product in a timely manner. **_What ... Individualized Care contributes to Cardinal Health_** Clinical Operations is responsible for providing clinical specialties support and expertise in the areas of… more
- Elevance Health (Mendota Heights, MN)
- …make an impact:** + Determines the medical necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization ... ** Clinical Ops Associate Medical Director** **Orthopedic Surgery** **Location:**...surgical and non-surgical treatments. + Performs first level provider appeals of coverage decisions. + Provides support and education… more
- Humana (St. Paul, MN)
- …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
- Fairview Health Services (St. Paul, MN)
- …medical policies to determine if the service meets medical necessity guidelines. + Review and determine appropriate clinical documentation to submit to ensure a ... experience + Epic experience + Knowledge of medical terminology and clinical documentation review **EEO Statement** EEO/AA Employer/Vet/Disabled: All qualified… more
- Highmark Health (St. Paul, MN)
- …to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. ... are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical… more
- Cardinal Health (St. Paul, MN)
- **_What Clinical Operations and Individualized Care contributes to Cardinal Health_** Clinical Operations is responsible for providing clinical specialties ... documenting patient health insurance benefit investigations, prior authorizations, and appeals , preferred + Knowledge of Medicare, Medicaid and Commercially insured… more