clinical criteria. Perform first level provider appeals of coverage decisions. Demonstrate and maintain knowledge...Anticipated End Date: 2025-02-24 Position Title: Associate Medical Director, Clinical Operations (Surgery...
and resolving complaints and appeals Required Skills/Experience: 2+ years of Care Management experience Experience...
and long-term care services! Assist member with filing and resolving complaints and appeals. Bachelor's degree or Registered...
, and accreditation requirements functions include but are not limited to appeals, case management, , utilization management. Participate... requirements functions include but are not limited to appeals, case management, utilization management,. This entails reviewing...
complaints and appeals. Required Skills/Experience: Preferred Skills/ Experience: 1. 2+ years of Care Management...
, OIG initiatives). Processing external quality audits, which includes distributing results, preparing rebuttals/appeals...
divisional workflow. Provides administrative and clinical support to physicians, nurse practitioners, fellows and support staff... for all required services, procedures, diagnostic tests and medications. Works with insurance companies regarding denials and appeals...
& Essential Functions: Provides administrative and clinical support to physicians, nurse practitioners, fellows and support... with insurance companies regarding denials and appeals process for denials regarding medications, supplies, procedures, testing...
. Job Duties & Essential Functions: Provides administrative and clinical support to physicians, nurse practitioners, fellows... with insurance companies regarding denials and appeals process for denials regarding medications, supplies, procedures, testing...
patients for appropriateness of admission type and setting, utilizing a combination of clinical information and InterQual... guidelines. The Utilization Review Nurse utilizes clinical skills to support the coordination and documentation and communication...
and quality reports for senior leadership to drive improvement initiatives. Serve as a liaison between clinical staff, patients...: Evaluates charts concurrently at prescribed intervals, analyzes patient clinical information to determine patient length of stay...
and quality reports for senior leadership to drive improvement initiatives. Serve as a liaison between clinical staff, patients...: Evaluates charts concurrently at prescribed intervals, analyzes patient clinical information to determine patient length of stay...
, and other clinical needs. Identify, de-escalate, and solve patient concerns as they arise Work with Quality and Compliance to ensure... or audits (CARF, OBHL, RHBA, state, DEA, fire, and alarm). Work alongside assigned Clinical Coordinator to assist...
experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity... administrator. Development of end to end payment Integrity reports like Data Intake, Audit Selections, Findings, Appeals, Medical...
reviewers, including the contracted physicians Conducts clinical review of appeals and grievances in a fashion... Director will report to the Senior Medical Director of Utilization Management, Member Appeals & Grievances, and Medical Policy...
into the practice management system. Follow up on outstanding claims, appeals, and denials to ensure timely resolution... with patients regarding balances, payment plans, and billing inquiries. Collaborate with clinical and administrative staff...
denial issues and submits technical and clinical appeals in a timely manner. Will mentor the AR Specialist team members... directly with payers to follow up on outstanding claims, files technical and clinical appeals, resolve payment variances...
Experience with Medicare/Medicaid billing issues and appeals Preferred Licenses & Certifications Admission (or eligibility... support to our clinical areas. These locations are home to departments such as Access Services, Compliance, Human Resources...
for additional information as needed, resolve discrepancies or denials, and initiate reconsiderations, appeals, or peer-to-peer..., and Outlook. Compiled and provided documentation and/or verbal clinical review where needed to substantiate medical necessity...
Valley Hospital is in the top 5% of more than 4,500 hospitals nationwide for clinical performance. The hospital has achieved... and Distinguished Hospital Clinical Excellence Award. Desert Valley Hospital, along with Desert Valley Medical Group, offers key...