- Centene Corporation (Austin, TX)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... a candidate who resides in Texas. **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
- Molina Healthcare (Florence, KY)
- …compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical ... in consistent and efficient manner. + Makes appropriate referrals to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care… more
- Molina Healthcare (New York, NY)
- …are eligible for Medicaid .** **We are looking for a RN Care Review Clinician with Prior Authorization experience. Candidates with Utilization Management (UM) ... and MLTC/LTC experience are highly preferred. Additional experience with appeals , quality review , and experience with data collection/reports.** **_Bilingual… more
- State of Colorado (CO)
- CDOC Mental Health Clinician (Social Worker/Counselor III) - Statewide Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4560190) Apply CDOC ... Mental Health Clinician (Social Worker/Counselor III) - Statewide Salary $6,750.00 -...transfer for inmates experiencing acute mental health crisis. Renders clinical direction to non- clinical staff in mental… 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
- State of Colorado (Denver, CO)
- Mental Health Clinician I - Forensics/Civil- Colorado Mental Health Hospital in Fort Logan Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4591133) Apply Mental Health Clinician I - Forensics/Civil- Colorado Mental Health Hospital in Fort… more
- State of Colorado (Denver, CO)
- …abilities and competencies necessary to the position through continuing education, clinical supervision, literature review and participating in discipline and ... Mental Health Clinician I/ Fort Logan Nursing Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4631071) Apply Mental Health Clinician I/… more
- VNS Health (Manhattan, NY)
- …for HEDIS or other related compliance or quality improvement initiatives. + Provides clinical support in the Grievance and Appeals process. + Participates in ... Range:$49.55 - $61.96 Hourly What You Will Do + Collaborates with clinical management and field clinicians to identify, develop and implement quality improvement… more
- State of Colorado (Colorado Springs, CO)
- …after successful completion of 12 months of service. Description of Job Mental Health Clinician : This position exists to provide clinical mental health skills as ... DEPARTMENT OF CORRECTIONS MISSION: $25,000 HIRING INCENTIVE FOR FULL-TIME CLINICAL PROFESSIONALS! If your goal is to build a...the mental health consultant and clinician in a designated parole region. This position is… more
- The Cigna Group (Bloomfield, CT)
- …The Nurse Clinician - RN is responsible for reviewing escalated clinical criteria reviews for providers, members and patient client advocates within the Prior ... Management Lead Analyst-Nurse Clinician - Accredo Job Description Summary...of experience is preferred in prior authorization or utilization review and appeals + Demonstrated proficiency with… 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
- Kepro (Indianapolis, IN)
- …and practice issues. + A strong knowledge of Quality Assurance (QA) and Utilization Review (UR). + A contemporary clinician who understands major trends in ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- University of Michigan (Ann Arbor, MI)
- …fast changing environment. + Ability to navigate the EHR to identify documents for review to provide accurate capture of clinical information. + Knowledge and ... applicable regulations. Overall, the manager utilizes project management skills, clinical knowledge and understanding of documentation and coding requirements to… more
- Northern Light Health (Brewer, ME)
- …+ Prints and tracks 485 plans of care to ensure electronic signature by the clinical manager or clinician . + Regularly reviews the Orders Audit to ensure timely ... the agency, in accordance with State and Federal Regulations. + Coordinates with clinical staff and management to correct identified problems and trends. + Assists… more
- Thomas Edison State University (Trenton, NJ)
- …components to maintain regulatory and accreditation compliance. -Assist with the review and selection of program candidates. -Monitor formative and summative program ... evaluation metrics. - Review and recommends revision of program curriculum. -Meet/exceed expected program outcomes and benchmarks. -Develop action plans if standards,… more