- Intermountain Health (West Valley City, UT)
- …write up clinical reviews for insurance audits and governmental insurance appeals using supporting documentation. 2. Assesses the appropriateness of clinical ... State regulations. 3. Works with Physician Advisors to obtain clinical support for appeals if needed. 4. Collaborates with Care Management, Utilization Review,… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN...external committees as delegated or assigned. Serves as a consultant to other departments or organizations as needed. Performs… more
- Elevance Health (Atlanta, GA)
- **Medical Director- Appeals (Primary Care-IM or FM)** **Location: This is a hybrid position. Candidates must live within 50 miles of an Elevance Health location.** ... programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor...discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May… more
- CVS Health (Austin, TX)
- …Care experience + Client processing experience + Precertification experience + Clinical Appeals experience **Education** Associates degree required BSN preferred ... in time zone of residence** As a QM Nurse Consultant you will be responsible for the review and...will be responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets… more
- American Red Cross (KY)
- …and their family and other attending healthcare professionals. + Act as a consultant to external health care personnel about clinical apheresis. + Assess ... alleviate human suffering. You can make a difference by volunteering in a position that appeals to you and allows you to use your unique skills and talents. The Red… more
- HCA Healthcare (Orem, UT)
- …consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials process, discharge planning, case ... with these functions + You will serve as a clinical resource and consultant to hospital case...reduction of payer denials and in the denial and appeals process, as requested by the Case Management Department… more
- State of Colorado (CO)
- …CAA Statewide Addic D&A 7/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 06/27/2024 Closing Date 12/31/2024 4:00 ... Description + Benefits + Questions Department Information $25,000 Hiring Incentives for Clinical Professionals for full time positions: Payout will be $5,000 after… more
- Elevance Health (Los Angeles, CA)
- …and implementing programs to improve quality, cost, and outcomes. + May provide clinical consultation and serve as clinical /strategic advisor to enhance ... Director Associates. + May be responsible for an entire clinical program. + Supports clinicians to ensure timely and...discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May… 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 a ... of 2.8% through June 2025. $25,000 Hiring Incentives for Clinical Professionals:Payout will be as follows: $5,000 after successful...of assigned unit or program. + Act as a consultant and provides training to facility, community, and state… more
- State of Colorado (Grand Junction, CO)
- …+ Supports and assists in training for the agency as needed. + Serve as a clinical consultant to unit manager and other clinical providers regarding the ... of Work Unit: This work unit exists to provide clinical services to committed and detained youth in a...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- CommonSpirit Health (Sacramento, CA)
- …validity and identify opportunities for overturning inappropriate denials. Leads the appeals process by providing clinical expertise, crafting compelling appeal ... a remote position.** **Summary** The Utilization Management Physician Advisor II conducts clinical case reviews referred by case management staff and/or other health… more
- Alameda Health System (Oakland, CA)
- …to new equipment and/or techniques. + Review cases regularly with staff; acts as clinical consultant regarding care management issues; guides clinical staff ... compliance studies. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with...Perform all other duties as assigned. + Performs daily clinical rounds and monthly audit of charts on care… more
- Alameda Health System (Oakland, CA)
- …to new equipment and/or techniques. -Reviews cases regularly with staff; acts as clinical consultant regarding care management issues; guides clinical staff ... Medicare and internal compliance studies. -Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals… more
- CareFirst (Baltimore, MD)
- …the prevention, reduction of and/or recuperation of losses to CareFirst through the clinical review of medical records and claims, resulting in the savings and/or ... recovery of funds. Responsible for providing clinical knowledge to the SI team to support both...in the providers/facility's practice. + When assigned act as liaison/ consultant inside corporation on cases, in cooperation with areas… more
- Elevance Health (Metairie, LA)
- …and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor to enhance ... Director Associates. + May be responsible for an entire clinical program. + Supports clinicians to ensure timely and...discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May… more
- Veterans Affairs, Veterans Health Administration (IN)
- …of PCAFC initial eligibility decisions; reassessments and appeal decisions for clinical eligibility determinations, within 45 days of receipt from facilities and ... record and collateral records for use in determining PCAFC clinical eligibility and document findings in approved CSP PCAFC...to coordinate with other regional CEATs the transfer of appeals for inter-VISN evaluation. Brings the knowledge of and… more
- Elevance Health (NC)
- …limited to the proper provision of covered services to Members, developing clinical practice standards, clinical policies and procedures, utilization management, ... programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor...discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May… more
- Elevance Health (Sacramento, CA)
- …and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor to enhance ... Medical Director Associates. May be responsible for an entire clinical program. **How you will make an impact:** +...discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May… more
- City and County of San Francisco (San Francisco, CA)
- …prepares written care summaries for the purpose of coordinating care; + Performs clinical evaluations in the more difficult individual cases by participating in the ... training and coordination of programs and services; acts as consultant to other agencies and participates in negotiation and...California Board of Behavioral Sciences (BBS) for + Licensed Clinical Social Worker (LCSW) OR + Licensed Marriage and… more
- Elevance Health (Norfolk, VA)
- …impact.** Responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of a Medical Director. ... for supporting one or more Medical Directors in ensuring clinical integrity of broad and significant clinical ...including medical policies. + Serves as a resource and consultant to other areas of the company. + May… more