Clinical Appeals - Indianapolis

The Clinical Appeals Nurse is responsible for processing clinical appeals and attending state hearings within compliance and regulatory standards, · clinical guidelines, and contractual obligations.Responsible for the completion of clinical appeals and state hearings from all sta ...

The Grievance & Appeals Specialist II reviews appeals submitted by Medicaid and Medicare providers and all future providers contracted with CareSource. · Prepare the appeals for clinical review · Review submitted appeals daily for validation of the appeal · ...

The Revenue Recovery Consultant is responsible for monitoring and analyzing government payer hospital patient claim payment variances to optimize revenue recovery.Essential Functions and Responsibilities: · Develop a knowledgebase of government payer regulations. · Analyze intern ...

+This role enables associates to work virtually full-time, with the maximum flexibility and autonomy. · +Conducts investigations and reviews of member and provider medical necessity appeals. · Reviews prospective, inpatient, or retrospective medical records of denied services for ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy promoting productivity supports work-life integration and ensures essential face-to-face onboarding and skill development. · Reviews analyzes and processes non-complex grievances and ap ...

+This is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple pro ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy investigating medical necessity appeals requests from members. · Conducts investigations and reviews of member and provider medical necessity appeals. · Reviews prospective inpatient or ...

The Behavioral Health Medical Director-Psychiatrist Appeals is responsible for the administration of behavioral health medical services. · ...

This is a remote work position that requires residency in KY or IN Research denials and/or suspected payment variances from all commercial and governmental payors including audits RACs or similar Medicare and Medicaid programs. · ...

This role requires associates to be in-office three days a week while providing flexibility to support productivity and work-life balance. · Interpret existing policies and develop new policies based on changes in the healthcare or medical arena. · Lead, develop, direct and imple ...

This is an entry level position in the Enterprise Grievance & Appeals Department that reviews, · analyzes and processes non-complex pre-service and post-service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple pr ...

We are seeking an experienced RN to join our team as a Case Manager at IU Health University Hospital. · Plan and coordinate patient care from admission through post-discharge. · Perform accurate and timely discharge planning, including documentation and communication. · ...

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. · You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. · ...

This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. · ...

Nurse Appeals is responsible for investigating and processing medical necessity appeals requests from members and providers. The role involves conducting investigations and reviews of member grievances and Quality of Care cases. It requires a HS diploma or equivalent and a minimu ...

This role enables associates to work virtually full-time, providing maximum flexibility and autonomy. · This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.,,,The Behavioral Health Medical Direct ...

The Behavioral Health Medical Director is responsible for reviewing cases for IN Medicaid members including child and substance use disorders, · Responsible for the administration of behavioral health medical services, · Conducts peer-to-peer clinical reviews with attending physi ...

The Behavioral Health Medical Director is responsible for reviewing cases for IN Medicaid members including child and substance use disorders, · Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties be ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy. · The Behavioral Health Medical Director is responsible for reviewing cases for Medicare members including child and substance use disorders, and all levels of care. · ...

+Job Summary · The Behavioral Health Medical Director enables associates to work virtually full-time with maximum flexibility and autonomy. · +The Behavioral Health Medical Director reviews cases for Medicare members including child and substance use disorders. · The Behavioral H ...