**Description** _Summary:_ Responsible for the management and communication of denialsappeals received from third party payers, managed care companies, andor government entitiesauditors related to medical necessity andor level of care. This associate will be a liaison and point of contact for clinical denials and appeal inquiries. The Clinical Appeals Nurse will review each case identifiedreferred for appeal based on Milliman Care Guidelines (MCG), InterQual, andor other relevant guidelines, determined the viability of the appeal, and manage the appeal process. The Clinical Appeals Nurse is responsible for appealing all inappropriate denials through all possible levels of the appeal process. The RN Clinical Appeals Nurse will actively manage, maintain and communicate denialappeal activity to appropriate stakeholders, and report suspected or emerging trends related to payer denials. Working with Case Management leadership, this individual will orchestrate education and other performance improvement initiatives to impact clinical quality, improve efficiency and mitigate lost revenue related to medical necessity denials. Key Performance and trends related to denialsappeals will be reported to the facility. _Responsibilities:_
...western U.S., helping them effectively manage their workers' compensation costs. Our headquarters... ...opportunity with us: the role of Field Premium Audit Manager. This will be a... ...employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance...
In House Counsel Jobs New York | JDHuntr 35443 General Counsel, New York, NY\ To apply go to JDHuntr.com \ The General Counsel will assist the Partners with most legal matters. This will include advising on day-to-day legal matters, financing transactions and ad hoc...
...Why USAA?Lets do something that really matters. At USAA, we have an important mission: facilitating the financial security of millions of U.S. military members and their families. Not all of our employees served in our nations military, but we all share in the mission...
Additional InformationJob Number: 24208130Job Category: Event ManagementLocation: JW Marriott San Francisco Union Square, 515 Mason Street, San Francisco, California, United States, 94102 VIEW ON MAPSchedule: Full TimeLocated Remotely? NPosition Type: Management...
.../contractor support. ~ Install or relocate equipment as necessary. ~ Maintain parts and tool inventories. ~ Keep all engineering areas orderly and clean. Basic Qualifications : ~ Minimum 8 years of experience in a related field and hospitality ~ HVAC...