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CVN CASE MANAGER

HINESVILLE, Georgia

SCM Associates, Inc. Logo
SCM Associates, Inc.

Los Angeles, California

CHRISTUS Health Logo
CHRISTUS Health

Santa fe, New Mexico

NEW! NEW!
PIH Health Logo
PIH Health

Whittier, California

NEW! NEW!
University of Maryland Medical System Logo
University of Maryland Medical System

Towson, Maryland

NEW! NEW!
University of Maryland Medical System Logo
University of Maryland Medical System

Towson, Maryland

NEW! NEW!
SageWest Health Care Logo
SageWest Health Care

Lander, Wyoming

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NEW! NEW!
CHRISTUS Health Logo
CHRISTUS Health

Santa fe, New Mexico

NEW! NEW!
Kindred Hospitals Logo
Kindred Hospitals

Dover, New Jersey

NEW! NEW!
PIH Health Logo
PIH Health

Downey, California

NEW! NEW!
Kindred Hospitals Logo
Kindred Hospitals

San Leandro, California

NEW! NEW!
ChristianaCare Health System Logo
ChristianaCare Health System

Wilmington, Delaware

NEW! NEW!
CommonSpirit Health Mountain Region Logo
CommonSpirit Health Mountain Region

Longmont, Colorado

NEW! NEW!
Duke University Health System Logo
Duke University Health System

Durham, North Carolina

NEW! NEW!
ChristianaCare Health System Logo
ChristianaCare Health System

Newark, Delaware

NEW! NEW!
WMCHealth Logo
WMCHealth

Suffern, New York

NEW! NEW!
Kindred Hospitals Logo
Kindred Hospitals

Paramount, California

NEW! NEW!
AdventHealth Logo
AdventHealth

Orlando, Florida

AdventHealth Logo
AdventHealth

Orlando, Florida

AdventHealth Logo
AdventHealth

Winter Garden, Florida

AdventHealth Logo
AdventHealth

La Grange, Illinois

Kindred Hospitals Logo
Kindred Hospitals

San Antonio, Texas

AdventHealth Logo
AdventHealth

Orlando, Florida

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Care Manager Clinical Denials
JOB SUMMARY: The Care Manager Clinical Denials (CM-CD) is responsible for the management of clinical audits and denials related to inpatient medical necessity and/or level of care, and coding. The CM-CD reviews patient medical records and all other pertinent patient information, and applies clinical and regulatory knowledge, screening criteria and judgment, as well as knowledge of payor requirements and denial reason codes/rationale, to determine why cases are denied and whether an appeal is required. For all inappropriate denials, relevant information is submitted, according to each payor's appeal timeframes, through denial management tracking software with bi-directional interface with physician advisor appeal coordinat


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