- Centene Corporation (Jefferson City, MO)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by… more
- Centene Corporation (Sacramento, CA)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... Position that Requires CA RN Licensure **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …health and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: $31.00-$49.24 PER HOUR REPORTS TO: ... and optimize reimbursement for external reviewers/third party payers. The Utilization Review Clinician maintains knowledge of, participates in further training… more
- State of Colorado (Sterling, CO)
- …Social Worker/Counselor III Mental Health Clinician /Gender Affirming Care - (STERLING) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4778415) ... Apply CDOC Social Worker/Counselor III Mental Health Clinician /Gender Affirming Care - (STERLING) Salary $6,750.00 -...Department of Corrections Mission: $25,000 HIRING INCENTIVE FOR FULL-TIME CLINICAL PROFESSIONALS! If your goal is to build a… more
- City and County of San Francisco (San Francisco, CA)
- …and + May perform Quality Improvement activities such as chart audit and compliance review . + The 2932 Senior Behavioral Health Clinician performs related duties ... Francisco continuously accepts applications for all permanent Senior Behavioral Health Clinician 2932 positions. Rather than publishing separate job ads for every… more
- City and County of San Francisco (San Francisco, CA)
- …of San Francisco continuously accepts applications for all permanent Behavioral Health Clinician 2930 positions. Rather than publishing separate job ads for every ... Homelessness and Supportive Housing and the Department of Public Health can then review your application and contact you directly with details about their positions.… more
- KidsPeace Childrens Hospital (Temple, PA)
- …clients, including the provision of individual, group and family therapy. The Senior Clinician also provides training on clinical issues to other staff as ... The Senior Clinician is primarily responsible for oversight and coordination...necessary and assists other sites on clinical issues when needed. QUALIFICATIONS: + Master's Degree in… more
- CVS Health (Frankfort, KY)
- … coverage, and policies. Responsible for the review and resolution of clinical complaints/grievances and appeals . Interprets data obtained from clinical ... requirements for member and provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required.… more
- State of Colorado (Denver, CO)
- …path and flexible working arrangements, click the link below to review additional benefits and perks https://cdphe.colorado.gov/careers Some positions may qualify ... that of a professional infection preventionist in hospital and outpatient clinical settings, including knowledge of preventable surgical site and device associated… more
- State of Colorado (Denver, CO)
- …Number CAA SWC I 82130 01/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 01/21/2025 Closing Date 2/4/2025 4:00 PM ... This position is eligible for full benefits** $25,000 Hiring Incentives for Clinical Professionals: Payout will be $5,000 after the completion of the academy,… more
- University of Virginia (Charlottesville, VA)
- …technicians, helping them navigate formulary restrictions and prior authorization requirements + Review and submit appeals for specialty medications + Review ... and submit prior authorizations for specialty medications + Review patient records, lab results, other clinical information to support prior authorization… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas ... anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in...clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care… more
- Glens Falls Hospital (Glens Falls, NY)
- …including charge discrepancies, CCI edits, and charge review * Serve as a clinical resource for appeals and denials * Review /update of Charge Master ... this role is for you! *Team Impact* As the Clinical Nurse Manager, you will provide overall clinical...of care in the event of staff absence * Review patient surveys and feedback and creates action plans… more
- CVS Health (Oklahoma City, OK)
- …Managed Care experience + Claims processing experience + Precertification experience + Clinical Appeals experience + Quality management experience + Experience ... care more personal, convenient and affordable. **Position Summary** Responsible for the review and evaluation of clinical information and documentation. Reviews… more
- Astor Services (Rhinebeck, NY)
- …out of network insurance organizations for Director of Billing & RCM to review and provide contractual recommendations. + Acts as a liaison between MCOs and ... to fulfill insurance credentialing requirements. + Maintains and updates Astor clinician employee list to fulfill insurance credentialing requirements. + Works… more