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Support resources for sexual misconduct, ASU's sexual misconduct policies, contact information for the Adams State University's Office of Equal Opportunity & Title IX, as well as a detailed procedure for filing a grievance due to discrimination on the basis of sex may be found online at.
$48,000 - $51,000 a yearExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Participates in leadership team by actively contributing in decision making, grievance follow up, building and company-wide initiatives and attending leadership team meetings such as daily stand up, daily clinical, Utilization Review (UR), Quality Assurancedaily Performance Improvement (QAPI) and other meetings as required.
$95 - $110 a yearTemporaryExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Ensure that the proper payment guidelines are applied to each claim by using the appropriate tools, processes, and procedures (e.g., claims processing policies & procedures, grievance procedures, state mandates, CMS/Medicare/Medicaid guidelines, benefit plans, etc.
$50,000 - $56,000 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Participates in leadership team by actively contributing in decision making, grievance follow up, building and company-wide initiatives and attending leadership team meetings such as daily stand up, Managing Acute Care Conditions (MACC), Nutrition at Risk (NAR), Utilization Review (UR), Quality Assurance Performance Improvement (QAPI) and other meetings as required.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Concurrent monitoring for compliance of standards identified as JC/CMS Grievance and/or patient complaints, and any other identified organizational priority. Acts as a subject matter expert for the Quality Institute staff and UH system stakeholders regarding clinical information for JC/CMS standards related to grievances and patient complaints.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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The Clinical Appeals Nurse will review each case identified/referred for appeal based on Milliman Care Guidelines (MCG), InterQual, and/or other relevant guidelines, determined the viability of the appeal, and manage the appeal process.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Participate in leadership team by actively contributing in decision making, grievance follow up, building and company-wide initiatives and attending leadership team meetings such as stand up, Managing Acute Care Conditions (MACC), Nutrition at Risk (NAR), Utilization Review (UR), Quality Assurance Performance Improvement (QAPI) and other meetings as required.
$40 an hourExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Implement the established plan of care and delegates in accordance with scope of practice in collaboration with the physician, Director of Nursing Services, clinical team members, social services, physical therapy, the resident and the residents family by tailoring care to meet individual needs of the resident.
$40 an hourExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Makes medical necessity determinations for grievance and appeals appropriate for their specialty. The DMEPOS Clinical Operations Associate Medical Directo r is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers pertaining to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance process that meets state, federal, accreditation and other regulatory requirements. Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations about appropriateness of care, and expedite cases within established criteria and contract requirements.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Prestige Care has a world class regional operations and clinical support team to ensure your success and a In-house SNF staffing pool of over 80 RN/LPN/CNA to assist you with any staffing needs.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. + Experience with national guidelines such as MCG or InterQual + Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialization + Advanced degree such as an MBA, MHA, or MPH + Exposure to Public Health principles, Population Health, analytics, and use of business metrics.
Work from homeExpandUpdated 4 days ago - UpvoteDownvoteShare Job
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May also engage in grievance and appeals reviews. The clinical scenarios predominantly arise from inpatient or post-acute care environments. Preferred Qualifications + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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You would be in a leadership position,overseeing the entire clinical and care program including coaching and teachingmany staff (Certified Nursing Assistant CNAs, Licensed Practical Nurses LPNs,and Registered Nurses RNs.
$125,000 - $145,000 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Responsibilities The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.
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