Clinical Appeals Author

We are seeking a detail-oriented and experienced Prior Authorization Specialist to manage  the full lifecycle of prior authorizations (PAs) for medical services. The ideal candidate will be responsible for timely submission, meticulous follow-up, and effective resolution of all prior authorization requests and subsequent appeals. This role is critical in...

Performs quality audits on clinical reviews needed to resolve and process appeals. Provides guidance on preparing case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal. Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards....

Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria,...

Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards.Roles and Responsibilities:Prepares case reviews for Medical Directors by researching the appeal,...

"Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards.Roles and Responsibilities:Prepares case reviews for Medical Directors by researching the appeal,...

Performs training and provides subject matter expertise on clinical reviews needed to resolve and process appeals. Provides guidance on preparing case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal. Ensures timely review, processing, and response to appeal in accordance with...

Performs training and provides subject matter expertise on clinical reviews needed to resolve and process appeals. Reviews medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards.Roles and Responsibilities:Provides guidance on...

At Limitlessli we specialize in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. Leveraging our extensive global network, we connect clients with highly qualified professionals, offering tailored services to meet our clients' unique business needs.The Opportunity:The Pre-Authorization Nurse is...

Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal. Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards. Communicates with providers, facilities and other departments regarding appeal requests. Generates...

Access Healthcare is looking for Registered Nurse to join our growing team.You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.Qualifications:Registered Nurse with Active license.Hospital Bedside experience (ER, ICU, Post Surgery,...