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Clinical Care Reviewer Utilization Management
AmeriHealth Caritas - 252 reviews - Philadelphia, PA
The nurse may need to follow the same process to review cases on appeal. Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible...
Medicare Audit Manager- Provider Audit and Reimbursement
First Coast Service Options, Inc. - Miami, FL 33101
Maintains and controls audit and appeal assignments, and also schedules manpower to meet performance requirements....
Physician - Family Medicine
Molina Healthcare - 567 reviews - Bothell, WA 98021
Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. Evaluates authorization requests in timely support of nurse reviewers and...

Behavioral Health Case Mgr I

Anthem, Inc. - 2,309 reviews - West Des Moines, IA
May also manage appeals for services denied. Family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination....

Coding Reviewer - Hospital Coding (Telecommuting)

PeaceHealth - 114 reviews - Vancouver, WA
Knowledge including, as appropriate, ICD-10, DRG methodology and HCPCS/CPT coding, regulatory Medicare, Medicaid and third party regulations....

Review Coordinator (Maryland)

Livanta - 13 reviews - Annapolis Junction, MD 20701  +1 location
Staffs the Medicare Beneficiary Helpline during work hours. Minimum of 2-4 years of experience in clinical decision making, relative to Medicare patients....

Coordinator-UtilizationMgt/Rvw

Loma Linda University Shared Services - 540 reviews - Loma Linda, CA
Reviews all finding and appeal letters with Denial Manager. Verifies Discharge Disposition of Medicare recipients as requested by HIM....

Physician Advisor

Orlando Health - 236 reviews - Orlando, FL
Essential Functions • Acts as second-level reviewer through the review of medical records of patients identified by care managers or as requested by the...

Grievance and Appeals Coordinator

Blue Cross Blue Shield of Michigan - 213 reviews - Detroit, MI
A.Member rights, b.Timely decisions about appeals, c.Fairness of the health plan's appeal decisions based on an independent reviewer....

Clinical Care Reviewer Utilization Management

AmeriHealth Caritas - 252 reviews - Philadelphia, PA
The nurse may need to follow the same process to review cases on appeal. Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible...

Quality Control Reviewer III

1199SEIU Family of Funds - New York, NY
Handle complex surgical, medical, vision, hearing aid and Medicare Part B claims; Log and update Medicare Secondary Payer (MSP) and other claim information on...

Manager Tele PAC Nurses- MDRT

eviCore healthcare - 151 reviews - Franklin, TN
Appeals and dispute resolution experience preferred. The MD Review Team (MDRT) Clinical Manager acts to mitigate denial and appeal provider grievances and ODAG...

Behavioral Health Reviewer

Meridian Health Plan - 101 reviews - Chicago, IL 60614 (Lincoln Park area)
A Day in the Life of a Behavioral Health Reviewer:. This position functions collaboratively with the members of the Behavioral Health Case Management team to...
Utilization Review Nurse
Washington Hospital Center - 232 reviews - Washington, DC 20022
Knowledge of reimbursement models (commercial, managed care, Medicare) is preferred. Serves as communication liaison between registered nurse case managers,...
Behavioral Health Case Mgr I - West Des Moines, IA - 133282
Anthem, Inc. - 2,309 reviews - West Des Moines, IA 50266
May also manage appeals for services denied. Family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination....

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