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Elevance Health
Overview
The Clinical Review Nurse I reviews prior authorization requests and clinical documentation to determine medical necessity and benefit coverage. They collaborate with providers to obtain necessary information and escalate complex cases to leadership and physician reviewers.
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Compensation
Salary not listed
Posted
5 days ago
Terros Health
This position is responsible for determining, documenting, auditing, and maintaining accurate and current enrollment, eligibility, and benefit coverage for clients/patients to ensure appropriate and timely reimbursement for services. Responsibilities include obtaining and reviewing available financial support options, reconciling discrepancies, and validating eligibility information in the electronic health record.
2 months ago
Cigna Healthcare
The Medical Assistant provides essential front and back-office support to providers in preparing for, examining, and treating patients within Worksite-based Health Centers. Key duties include patient check-in, verifying coverage, obtaining history and vitals, administering medications, and managing administrative tasks like scheduling and answering phones.
Monadnock Community Hospital
The specialist ensures timely and accurate use of referrals by monitoring appropriateness and medical necessity, performing telephonic support for authorizations, and coordinating referrals with insurance carriers. This role also involves processing physician referral orders, entering notes into the EMR system (eCW), and scheduling office visits based on incoming referrals.
4 months ago
Indiana Regional Medical Center
The specialist will be responsible for verifying patient insurance eligibility, benefits, and authorization requirements before or during services, and obtaining necessary initial and continued insurance authorizations for inpatient stays. This role also involves communicating coverage details and financial obligations to patients and staff, and ensuring medical documentation aligns with payer guidelines.
5 months ago
