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Kindred Hospitals

Dallas, Texas

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Kindred Hospitals

Gardena, California

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Hinsdale, Illinois

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Palm Coast, Florida

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Raleigh, North Carolina

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Westminster, California

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Palm Coast, Florida

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Palm Coast, Florida

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Apopka, Florida

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Palm Coast, Florida

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PIH Health

Whittier, California

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University of Maryland Medical System

Towson, Maryland

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SageWest Health Care

Lander, Wyoming

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CHRISTUS Health

Santa fe, New Mexico

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ChristianaCare Health System

Newark, Delaware

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AdventHealth

Deland, Florida

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Yuma Regional Medical Center

Yuma, Arizona

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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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