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The Clinical Review Nurse will be responsible for reviewing and processing prior authorizations for outpatient services, procedures, referrals, and Durable Medical Equipment (DME). This role involves evaluating requests using MCG guidelines and health plan criteria while ensuring the completeness and medical necessity of medical records. The nurse will also coordinate with providers to identify missing documentation and route denials to the Medical Director as necessary.
Posted 71 days ago
Provide frontline care to homeless patients.
Manage patient panels with diverse health needs.
Posted 61 days ago
Provide comprehensive medication management for oncology patients.
Collaborate with healthcare providers to create care plans.
Posted 61 days ago
Provide medication management for oncology patients.
Collaborate with healthcare teams for patient care.
Posted 56 days ago
Manage prior authorizations for patients.
Source financial assistance for medication access.
Posted 46 days ago
Optimize prior authorization workflows.
Enhance interoperability in healthcare.
Posted 42 days ago
Conduct medical necessity reviews per guidelines.
Gather clinical records for assessments.
Posted 19 days ago
Manage patient relationships effectively.
Support patients with medication management.
Posted 12 days ago
Join our rapidly expanding healthcare organization as a Bilingual Pharmacy Liaison. In this role, you will provide essential patient support in a Spanish clinic setting, ensuring timely medication delivery and addressing insurance challenges. Collaborate with clinical pharmacists and healthcare providers to advocate for patients navigating complex therapies. With a competitive salary, generous PTO, and immediate health benefits, this opportunity offers significant career growth in a supportive environment.
Coordinate medication delivery and refills.
Posted 7 days ago
Join a dynamic team as an RCM Claims Status Manager, where you'll lead a remote group of specialists dedicated to enhancing claim resolutions and payer communications. This pivotal role involves managing electronic inquiries, documenting responses, and ensuring compliance with service level agreements. With over five years in healthcare billing operations and a strong grasp of claims workflows, you will identify trends and resolve discrepancies effectively. This is an exciting opportunity to drive improvements in revenue cycle management and contribute to the financial health of healthcare services.
Oversee electronic claim inquiries and payer communications.