- Centene Corporation (Little Rock, AR)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. + Maintain files and logs for all appeals +… more
- Henry Ford Health System (Troy, MI)
- RN PROVIDER APPEALS COORDINATOR - MEDICAL APPEALS - 40 HOURS WEEKLY - DAY SHIFT Full Time Benefit Eligible Schedule: Monday through Friday, 8:00AM to 4:30PM. ... Alliance Plan (HAP) is looking to grow our Medical Appeals Team with an experienced Registered Nurse! We are...+ Minimum of two (2) years of experience in clinical management of patients in an inpatient or ambulatory… more
- Centene Corporation (Indianapolis, IN)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- CVS Health (Baton Rouge, LA)
- …Must reside in Louisiana Responsible for intake, investigation and resolution of appeals , complaints and grievances scenarios for all products, which may contain ... responses from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance. Identify trends and emerging issues and report… more
- State of Colorado (Golden, CO)
- Medical Operations Coordinator (Nurse V) - Lookout Mountain Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5166280) Apply ... Medical Operations Coordinator (Nurse V) - Lookout Mountain Youth Services Center...level supervisor, contributes to the evaluation of medical and clinical performance of all DYS medical staff as needed,… more
- Elderwood (Waverly, NY)
- …handles Third Party appeals , peer to peers as applicable and with clinical oversight provided by the LPN/RN MDS Coordinator . Attends team meetings at ... Salary $ 20 / $ 22 Overview Managed Care Coordinator Overview Mon-Fri 8am-4pm The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator … more
- Community Health Systems (Antioch, TN)
- **Job Summary** The Denial Coordinator is responsible for reviewing, tracking, and resolving denied claims, ensuring that appropriate appeals are submitted, and ... Hyland, BARRT, and other host systems, ensuring timely follow-up on denials and appeals . + Conducts follow-up calls and payer portal research to track the status… more
- Adelphi University (Garden City, NY)
- …liaison ensuring that candidates experience continuity and support across academic and clinical settings. The Coordinator monitors Manhattan Center RSA CEHS ... NYC Education Program Coordinator Job Department/School College of Education and Health...Teacher Examination and Workshop dates and deadlines. + Oversee clinical practice supervision to ensure candidates receive ongoing support… more
- HCA Healthcare (Manchester, NH)
- …care like family! Jump-start your career as a Medical Staff Services Coordinator today with Catholic Medical Center. **Benefits** Catholic Medical Center, offers a ... Come join our team as a Medical Staff Services Coordinator . We care for our community! Just last year,...play a key role in the integration of HCA Clinical Strategies and HCA systems. 1. Medical Staff Administration… more
- System One (Las Vegas, NV)
- Job Title: LTSS Coordinator - Nevada Location: Nevada Type: Contract Compensation: $33/Hour Contractor Work Model: Remote Title: LTSS Coordinator - Nevada ALTA ... Data & Advanced Analytics, and Agile Transformation Services. The LTSS Coordinator - Nevada monitors and promotes effective utilization of long-term services… more
- Cedars-Sinai (Beverly Hills, CA)
- …innovation. **A Little More About What You Will be Doing** The RN Care Coordinator is responsible for the case management of patient while hospitalized and upon ... In collaboration with the Inpatient Specialty Program (ISP) hospitalists, the RN Care Coordinator will assist patients from the time they are admitted until they are… more
- State of Massachusetts (Boston, MA)
- …and child disabilities to fill the role of*Regional Social Security Benefits Coordinator *. Reporting to the Social Security Benefits Manager, the selected candidate ... benefits (eg, Veteran's Benefits, Railroad Benefits, etc.). The Regional Social Security Benefits Coordinator will act as a consultant to Regional and Area DCF staff… more
- Sacramento County (Sacramento, CA)
- Treatment Center Program Coordinator Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1180508) Apply Treatment Center Program Coordinator ... management with emphasis on health occupations + Principles and techniques of clinical interviewing, diagnosis, and treatment + Most current version of the Diagnosis… more
- US Tech Solutions (RI)
- …with other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). + Identify and elevate clinical inquiries to the ... + Maintains complete, timely and accurate documentation of reviews. + Transfers all clinical questions, escalations and judgement calls to the pharmacist team. + The… more
- Rochester Regional Health (Rochester, NY)
- …implements training to ensure compliance with the revenue cycle focusing on clinical documentation, coding, charging, billing, and denial appeals for physicians, ... Full-Time, 40 hours/weekSchedule: Day Shift SUMMARY: The Senior Corporate Compliance Coordinator plays a critical role in minimizing organizational risk by… more
- Elevance Health (Tampa, FL)
- **LTSS Service Coordinator (Bilingual in Spanish/English Preferred)** **Schedule:** Monday-Friday 8am-5pm **Location** _:_ This is primarily a field based position. ... an accommodation is granted as required by law._ The **LTSS Service Coordinator ** is responsible for conducting service coordination functions for a defined caseload… more
- Elevance Health (OH)
- **LTSS Service Coordinator (Case Manager)** **Candidates should live in one of the following counties:** Auglaize, Coshocton, Defiance, Gallia, Harrison, Holmes, ... long term services and supports, and psychosocial needs. The **LTSS Service Coordinator ** is responsible for managing service coordination for a designated caseload… more
- Elevance Health (Viroqua, WI)
- **LTSS Service Coordinator (Case Manager)** **$5,000 Sign-on Bonus** **Hiring near Southwestern Wisconsin in counties:** Pepin, Buffalo, Trempealeau, Jackson, Clark, ... living, employment, and contributing to their communities. The **LTSS Service Coordinator ** is responsible for conducting service coordination functions for a… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non- clinical tasks related to processing ... Utilization Management prior authorization sand appeals . JOB RESPONSIBILITIES + Monitor incoming faxes + Enter...expected timelines EXPERIENCE: + 1 year as a UM Coordinator in a managed care payer environment preferred +… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals ... activities. This role collaborates with payers, hospital staff, and clinical specialists to secure timely authorizations for hospital admissions and extended stays.… more