analytics, AI, intelligent automation, and workflow orchestration. As our Clinical Appeals Supervisor, you will help support... is essential for excelling in this remote position. Here’s what you will experience working as a Clinical Appeals Supervisor...
setting The Clinical Appeals Reviewer reports to the Supervisor, Appeals and Grievances and is responsible for processing...Clinical Appeals Reviewer Newtown Square, PA/Remote 13 weeks 3 or more years’ experience in a related clinical...
analytics, AI, intelligent automation, and workflow orchestration. As our Clinical Appeals and Denials Manager, you will serve... as an expert on clinical appeals and denials management. Every day you will support client hospitals where claims were denied...
Medical Reviewer - Clinical Appeals Consultant - Medical Necessity Job Summary: The Independent Medical Reviewer... assist in preventing and lowering denials and reducing the cost of the claims appeals process. Job Title: Independent...
SUMMARY: Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits... or improvement. 2. Assures clinical interventions are appropriate for the admitting diagnosis and reflect the standard of care...
PRINCIPAL RESPONSIBILITIES: Under general direction of the Grievance and Appeals Leadership, the Grievance and Appeals... and identify key policy provisions such as clinical guidelines, plan policies, EOC, regulatory guidelines, and DMHC/DHCS rules...
Job Description: PRINCIPAL RESPONSIBILITIES: Under general direction of the Grievance and Appeals Leadership, the... Grievance and Appeals (G&A) Coordinator II will review, investigate and process non-complex grievances for all lines of business...
Overview: Now hiring a full time Denial/Appeals Specialist! Responsible for tracking, appealing and resolving... with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact...
Overview Now hiring a full time Denial/Appeals Specialist! Responsible for tracking, appealing and resolving denied.... From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided...
appeal correspondence to Payers, while adhering to business process standards and/or review clinical documentation to meet... activity. Collaborate with the Supervisor for appropriate response to audit findings. Communicate audit observations...
JOB RANGE: Supervisor Clinical Denials $71,094.40-$97,763.33 INCENTIVE: EQUAL OPPORTUNITY EMPLOYER It is the policy of Franciscan... as well as clinical denial services. Participate and educate team in performance improvement initiatives. Implement...
and comprehensive aftercare plans with placement. Services include clinical assessment, treatment planning, individual therapy, group... treatment team. Group therapy is offered to all patients and group assignment shall be determined by clinical and individualized...
, or Ambulatory Manager as applicable. Under the supervision of the Pharmacist-In-Charge, Pharmacy Supervisor, Senior Clinical... Pharmacist Specialist, or Clinical Coordinator is responsible for the interpretation, evaluation, preparation, and dispensing...
and communities. To learn more about who we are at Point32Health, click . Job Summary The Medical Director, Clinical reviews..., concurrent, and retrospective utilization reviews including both member-facing initial reviews and appeals. They will work...
, or Ambulatory Manager as applicable. Under the supervision of the Pharmacist-In-Charge, Pharmacy Supervisor, Senior Clinical... Pharmacist Specialist, or Clinical Coordinator is responsible for the interpretation, evaluation, preparation, and dispensing...
grievances and appeals, to the supervisor or an appropriate management official. Communicate team consensus and recommendations.... Also, assists the supervisor with day-to-day functions of the Ambulatory Care Unit. Scope of Work: This position is located in the...
*must have Masters Degree, Certified Clinical Supervisor certificate, and minimum of 2 years supervisory experience... Counselor Certified Clinical Supervisor American Society of Addiction Medicine board certification American Psychology...
supervision of the Pharmacist-In-Charge, Pharmacy Supervisor, Senior Clinical Pharmacist Specialist, or Clinical Coordinator... therapeutic appropriateness of the patient’s drug regimen as it relates to the patient’s clinical status, concomitant drug therapy...
authorization questions for patients Clinical Staff Works with Clinical Supervisor to provide requested information... operations Clinical experience Knowledge of medications Commitment to “cross training” assigned tasks Commitment to customer...
clinical, environmental, and social to establish an individual plan of care needed to maintain the member safe in the community... from providers, members, and care management team and renders clinical determinations in accordance with VNS Health Plans policies...