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ProvidenceNew
Overview
Manages patient admissions to ensure optimal availability and utilization of clinical and medical center resources. Monitors medical records for variances to financial and clinical standards to achieve the best patient outcomes.
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Compensation
$69 - $107 / HOUR
Posted
New
Best Care
This role is responsible for the overall management and communication of clinically-based appeals between the Health System and various payers, requiring review of cases, utilization of guidelines, and management of appeal documentation and communication.
Salary not listed
3 months ago
KPC GLOBAL MEDICAL CENTERS INC.
The Clinical Appeals Nurse investigates and processes medical necessity appeals from members and providers to payers, requiring research into standards, regulations, and policy to overturn or uphold denied claims. This role involves ensuring timely and accurate processing of all denials according to policies and requirements, and preparing cases for Medical Director review when necessary.
$52 - $62 / HOUR
