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Apr 19 Clinical Appeals Specialist RN WFH Parallon Norcross, GA

Handles appeals requiring clinical input or interpretation SUPERVISOR - Logging Manager SU ... companies toresolve claims denied for clinical reasons? Identify coding or clinical... more

Apr 16 Appeals Coordinator Cameron Craig Group Pittsburgh, PA

precedence with key payers. Leverage clinical expertise related to cardiac care; ... as a hospital or payer based case manager or discharge planner. Excellent clinical... more

Apr 15 Pharmacy Technician Prior Authorization and Appeals (157587BR) CVS Caremark Honolulu, HI

all approvals and denials, and transfers all clinical questions and judgement calls to the pharmacist. Required Qualifications Ability to deal with a diverse customer base in a... more

Apr 15 Clinical Admin Nurse, Appeals UnitedHealth Group Cypress, CA

Billing Business Operations Claims Clinical & Mental Health Professionals ... Legal Marketing and Advertising Medical & Clinical Operations Network Contract... more

Apr 14 Clinical Appeals Specialist RN/LPN (WFH) Parallon Largo, FL

Job Summary – Handles appeals requiring clinical input or interpretation Key ... for clinical reasons Identify coding or clinical documentation issues and work to... more

Apr 14 Senior Clinical Appeals RN – Sacramento UnitedHealth Group California

Billing Business Operations Claims Clinical & Mental Health Professionals ... Legal Marketing and Advertising Medical & Clinical Operations Network Contract... more

Apr 12 RN/ Registered Nurse Clinical Appeals Horizon Healthcare Staffing Brooklyn, NY

RN/Registered Nurse Clinical Appeals Excellent opportunity ! Horizon Healthcare is seeking ... reviews for provider and vendor appeals RN/Registered Nurse Clinical Appeals... more

Apr 11 RN Case Manager - Appeals Adventist Healthcare Rockville, MD

Hospital is searching for a RN Case Manager with appeals experience! This is a ... Case Management experience with appeals requiredStrong customer service... more

Apr 09 Product Manager EMR Clinical Software Thorndale Partners Boston, MA

Product Manager ndash EMR Clinical Record software (Boston, MA) Core Requirements 2+ years ... environment. Strong understanding of clinical work flow and vernacular Experience... more

Apr 09 Pharmacist Clinical Med D (151796BR) CVS Caremark Scottsdale, AZ

Responsible for reviewing clinical appeals, coverage determinations & exceptions, ... the organization. Required Qualifications *Clinical pharmacy knowledge *Data review... more

Apr 07 Care Manager Audit Appeals (129990) Texas Children's Hospital Houston, TX

The Care Manager - Audit/Appeals (Appeals) has primary accountability for managing the app ... The Care Manager - Audit/Appeals (Appeals) maintains the ability to function as a member o... more

Mar 23 Clinical Appeals Manager - PROFESSIONAL: REVENUE CYCLE Parallon Workforce Solutions Largo, FL

Title/Unit: Clinical Appeals Manager Shift/Schedule: Full-Time Located on the West Coast o ... of Gulf coastline! Description: The Clinical Appeals Manager manages all activities... more

Mar 19 Pharmacist Clinical Med D (135377BR) CVS Caremark Scottsdale, AZ

Responsible for reviewing clinical appeals, coverage determinations & exceptions, ... the organization. Required Qualifications *Clinical pharmacy knowledge *Data review... more

Mar 19 Clinical Appeals RN - Cypress, CA or Telecommuter Diversified Managed Health Care Company California

clinical reviews to ensure compliance with clinical standards, appeal/grievance ... for reviews for the Medicare Provider appeals. Your primary responsibilities would... more

Mar 18 Member Services Clinical Consultant(236005) Kaiser Permanente Oakland, CA

Provides/gathers clinical expertise for areas of compliance which involve medical necessit ... Utilizes clinical expertise to conduct investigations and seek input from other clinical p... more

Mar 17 Clinical Appeals RN - Cypress, CA or Telecommuter UnitedHealth Group Cypress, CA

Billing Business Operations Claims Clinical & Mental Health Professionals ... Legal Marketing and Advertising Medical & Clinical Operations Network Contract... more

Mar 10 Registered Nurse RN Clinical Appeals Specialist Multicare Health System Tacoma, WA

Summary: The RN Clinical Appeals Specialist is responsible ... coordination; management and resolution of clinical denials for the Access Services... more

Feb 28 Senior Clinical Appeals RN – Phoenix UnitedHealth Group Arizona

Billing Business Operations Claims Clinical & Mental Health Professionals ... Legal Marketing and Advertising Medical & Clinical Operations Network Contract... more

Feb 25 Registered Nurse for Clinical Documentation Specialist at Memorial Health Tenet Healthcare Chattanooga, TN

education. * CDI: Communicates/Completes Clinical Documentation Improvement (CDI) ... and professionally with other clinical and non-clinical clients *... more

Feb 22 TRICARE Part Time Appeals Medical Director - 25 hrs/week - West Coast Virtual Diversified Managed Health Care Company Colorado

Appeals and Grievances team as well as the Clinical Quality Management team. The Medical ... clinical programs and policies. Provides clinical education to clinical staff to... more

Feb 20 MLTC - Various Nursing, Clinical, Management and Director Positions Managed Care Organization New York, NY

positions• Appeals and Grievance Department Managers – RN Required• QC Managers (HEDIS)- LCSW, LPN or RN +4 year degree (telecommute)• PI/QI/ QA Managers – RN Required• Nurse... more

Jan 23 Lead Clinical Appeals Nurse Sinai Hospital of Baltimore Baltimore, MD

Lead Clinical Appeals Nurse Oversees the LBH clinical appeals daily operations and ... Minimum of two years experience in case management/utilization management/clinical appeals... more

Dec 09 Lead Clinical Appeals Nurse LifeBridge Health Baltimore, MD

Oversees the LBH clinical appeals daily operations and workflow. Serves as a clinical ... Minimum of two years experience in case management/utilization management/clinical appeals... more

Jul 08 Appeals & Grievances Clinical Specialist (RN) Execu|search Group Manhattan, NY

Appeals & Grievances Clinical Specialist (RN) Appeals & Grievances Clinical Specialist ... case manager to take on a role as an Appeals & Grievances Clinical Specialist. more

Jun 10 Medical Audit Appeals Spec (RN or RHIA) (127582) Texas Children's Hospital Houston, TX

Job Description Job Title Medical Audit/Appeals Spec (RN or RHIA) Job ID 127582 Locat ... of appeals and specific time limitations for appeals. Skills Required for completely... more

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