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Bakersfield Behavioral Healthcare Hospital
Overview
The specialist reviews medical records to prepare clinical appeals and manage authorizations and denials for patients. They coordinate with external case managers and insurance organizations to ensure certification of benefits and guide the treatment team on requirements.
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Compensation
$27 - $33 / HOUR
Posted
29 days ago
Healthcare Outcomes Performance Co. (HOPCo)
The Case Manager/Utilization Review Nurse coordinates patient-centered care across the continuum by conducting concurrent and retrospective reviews to verify medical necessity and applying standardized clinical guidelines. This role involves issuing pre-authorizations, collaborating with providers and payers, and facilitating communication to ensure optimal transitions and progression in care.
Salary not listed
3 months ago
KPC GLOBAL MEDICAL CENTERS INC.
The Clinical Appeals Nurse investigates and processes medical necessity appeals from members and providers to payers, requiring research into standards, regulations, and policy to overturn or uphold denied claims. This role involves ensuring timely and accurate processing of all denials according to policies and requirements, and preparing cases for Medical Director review when necessary.
$52 - $62 / HOUR
