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Acentra Health, LLC
Overview
The RN Clinical Assessor educates and performs medical eligibility assessments for WV Medicaid recipients seeking community-based services. This role involves managing a caseload, conducting assessments, and ensuring compliance with prescribed guidelines.
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Compensation
$53,840 - $70,000 / YEAR
Posted
3 days ago
St. Luke's University Health Network
The RN Clinical Review Appeals Specialist conducts retrospective reviews of patient medical records and claims data to ensure accurate coding and DRG assignment. They develop appeal arguments and facilitate communication with various stakeholders to resolve documentation and coding issues.
Salary not listed
7 days ago
Gainwell Technologies LLC
The DRG Nurse Reviewer Appeals and Hearings coordinates and performs all appeal-related duties, including analyzing and responding to provider appeals and preparing case files for hearings. The role also involves participating in hearings and assisting in training new reviewers.
$90,000 - $99,000 / YEAR
8 days ago
Prime Therapeutics
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, requiring interaction with physicians and providers to discuss determinations and provide clinical rationale for appeals. The reviewer also assists in maintaining consistency by utilizing clinical review guidelines and participating in training and research activities related to utilization management.
$91 - $154 / HOUR
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, often interacting with physicians and management staff. Responsibilities include discussing determinations with requesting providers and providing clinical rationale for standard and expedited appeals.
The Physician Clinical Reviewer provides timely medical review of service requests that do not meet initial medical necessity guidelines, routinely interacting with physicians and staff. Responsibilities include discussing determinations with requesting providers, providing clinical rationale for appeals, and ensuring consistency using medical review guidelines.
The Physician Clinical Reviewer conducts timely medical reviews of service requests that do not meet initial necessity guidelines. They also provide clinical rationale for appeals and act as a resource for the utilization management team.
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, requiring routine interaction with physicians and management staff. Responsibilities include discussing determinations with requesting providers within regulatory timeframes and providing clinical rationale for standard and expedited appeals.
The Physician Clinical Reviewer provides timely medical review of service requests that do not initially meet medical necessity guidelines, interacting with providers and staff as needed. Responsibilities include reviewing complex cases, discussing determinations with requesting physicians, providing clinical rationale for appeals, and ensuring compliance with various guidelines and policies.
BRIA Health Services
The Regional Medicaid Coordinator will assist facility business office managers with challenging Medicaid applications and provide oversight for PASRR/DON within Assessment Pro. This role is responsible for facilitating the timeliness of Medicaid applications, redeterminations, admit packs, and appeals/denials.
9 days ago
ORTHOCINCY
This role involves contributing to excellent orthopaedic care by completing data entry and coding for all services provided within the multi-specialty practice. Key duties include collecting, reviewing, and coding all charges, maintaining compliance, and educating providers regarding billing charges.
22 days ago
The Regional Medicaid Coordinator will assist facility business office managers with problematic Medicaid applications and provide oversight of PASRR/DON in Assessment Pro. This role facilitates the timeliness of various applications, redeterminations, and appeals, while also training staff on relevant Medicaid processes and systems.
23 days ago
Alignment Health
Review prior authorization requests for medical necessity using CMS and MCG guidelines to ensure high-quality, cost-effective care. Collaborate with providers and medical directors to process referrals and manage appeals and grievances.
$77,905 - $116,858 / YEAR
University of Utah Health
The Chaplain assesses spiritual care needs and develops treatment plans for patients and families while providing support to hospital staff. They coordinate religious rituals and collaborate with interdisciplinary teams to enhance patient well-being during crises or end-of-life care.
24 days ago
Federal Hearings And Appeals
The Physician Peer Reviewer is responsible for reviewing medical case files and making medical determinations regarding medical necessity and appropriateness. This includes analyzing Federal and State laws, regulations, and applicable policy guides.
25 days ago
Elevance Health
The Psychologist Reviewer collaborates with providers and Medical Directors to determine the appropriateness of care levels based on medical necessity criteria. They also conduct pre-certification, concurrent reviews, and appeals for behavioral health services while mentoring care management staff.
$93,120 - $167,616 / YEAR
1 month ago
UHS
The coordinator monitors treatment activities for mental health and dual diagnosis patients to ensure quality care and continuity. They perform concurrent reviews for inpatient and outpatient services and manage the appeals process until final decisions are reached.
UNITED MEDICAL DOCTORS
The role involves managing prior authorizations for sleep-related services and coordinating insurance eligibility. Additionally, the candidate will perform medical assistant duties such as rooming patients, obtaining vital signs, and assisting providers with examinations.
$21 - $25 / HOUR
Horizon Rehabilitation Hospital
The PPS Coordinator manages compliance with Medicare Inpatient Rehabilitation Facility regulatory requirements, including IRF-PAI reporting and the CMS Review Choice Demonstration program. This role acts as the primary liaison between the facility, CMS, and internal teams to oversee medical review submissions and audit readiness.
West Pines Behavioral Hospital
The Utilization Specialist acts as a liaison between managed care organizations and clinical staff to coordinate reimbursement and monitor patient length of stay. They are responsible for conducting medical necessity reviews, managing the appeals process, and providing staff training on documentation requirements.
$28 - $34 / HOUR
