- Guardian Life (Bethlehem, PA)
- …with Group Disability claims experience to join our dynamic Appeals Team. The ** Appeals Case Manager II** (ACM 2) is responsible for adjudicating ... assigned appeals for Group Life and Disability claims. The ACM...Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals . You are A highly motivated and reliable individual… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
- VNS Health (Manhattan, NY)
- …to, Provider Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances. + Ensures ... to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans...operational and regulatory compliance. Maintains and ensures integrity of case file and data collection systems and prepares data… more
- CVS Health (Tallahassee, FL)
- …Summary** Coordinate effective resolution of member and/or provider/practitioner appeals , complaints and grievances. Responsible for the day-to-day management ... of staff to ensure effective resolution of member or provider/practitioner appeals , complaints and grievances for all products, which may contain multiple issues… more
- Elevance Health (Meridian, ID)
- …benefit coverage issues. Triages clinical and non-clinical inquiries, grievances and appeals , prepares case files for member grievance committees/hearings. **How ... **Title: Grievance & Appeals Coordinator** **Location:** This position will work a...Contacts members to gather information and communicate disposition of case ; documents interactions. + Generates written correspondence to members,… more
- Conduent (Hamilton, NJ)
- …and Health Services (DMAHS) of New Jersey. **Reports To** This position reports to the Appeals Supervisor and the Appeals Manager . The Appeals ... a culture where individuality is noticed and valued every day. Fair Hearing Appeals Agent $18.50/ Hourly Onsite- Hamilton, NJ Full-time and Full Benefits **Location… more
- Point32Health (MA)
- …here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Senior Manager of Appeals and Grievances the Appeals and Grievance ... and provide leadership for the daily operations of the Appeals and Grievances department. The Supervisor represents the ...for many cross department and divisional interfaces (ie advising case managers in the field, responding to requests from… more
- New York State Civil Service (Melville, NY)
- …by the Workers' Compensation Law;* Assisting in the assignment of cases when the Appeals Unit Manager is absent for extended periods;* Assisting the Legal ... State Title Assistant Attorney 2/ Assistant Attorney 3 / Senior Attorney - Appeals (NY HELPS) Occupational Category Legal Salary Grade NS Bargaining Unit PS&T -… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: Knowledge of state, federal and regulatory requirements in Appeals /Care/ Case /Utilization Management/Quality. Strong verbal and written communication ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category:...culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the A&G Leadership in… more
- Houston Methodist (Houston, TX)
- …S Fry Katy, TX 77450** **Looking for candidates with the following:** + ** Appeals with hospital accounts** + **Epic experience is a plus** + **Government Advantage ... Revenue Cycle experience** At Houston Methodist, the Accounts Receivable (AR) Appeals Denials Specialist position is responsible for reviewing accounts which have… more
- The Cigna Group (Bloomfield, CT)
- …data system. Proactively communicates with appellants, leadership team, providers and the original case manager to resolve investigation issues and to ensure the ... limited to:** + Ability to differentiate different types of requests Appeals , Grievances, coverage determination and Organization Determinations in order to ensure… more
- Elevance Health (Meridian, ID)
- **Title: Grievance/ Appeals Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The **Grievance/ Appeals Representative I** is responsible for reviewing, analyzing and processing claims in accordance with policies… more
- Board of Veterans Appeals (Washington, DC)
- Summary The Board of Veterans' Appeals ' mission is to honor America's promise to its Veterans by timely resolving their appeals under the law. The Board of ... Veterans Affairs in deciding all questions of law and fact resolving Departmental appeals that affect the provision of benefits to Veterans, their dependents and… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **RN/ Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals + Communicates clinical information to the payor, as… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Case Manager is responsible for all aspects of case management/ utilization review for an assigned group of inpatients, ED patients ... and identify the expected length of stay (ELOS). The case manager works collaboratively with physicians, social...with physicians and managed care companies on concurrent denial appeals * Communicates clinical information to the payor, as… more
- Houston Methodist (Baytown, TX)
- At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible for functional and operational aspects of the Case Mgmt./Social Work ... corporate and hospital administrators, medical staff, and defined customers related to the Case Mgmt. system. The Manager Case Mgmt./Social Work position… more
- Sharp HealthCare (La Mesa, CA)
- …Start Time** **Shift End Time** Master's Degree; Bachelor's Degree in Nursing; Accredited Case Manager (ACM) - American Case Management Association (ACMA); ... Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN)...Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers.Review all cases with readmission… more
- Pfizer (Memphis, TN)
- **SUMMARY** Patient Case Manager is a non-promotional support role (within Pfizer's Specialty Access Solutions & Patient Support team) that facilitates patient ... and follow-up support, etc.. This individual will report directly to Director, Patient Case Manager (PCM), Specialty Access Solutions and Patient Support. The… more
- Select Medical (Los Angeles, CA)
- …Joint Venture with Cedars, UCLA and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse (RN) or Licensed ... at Cal Rehab have a high discharge to home rate. **Benefits of working as a Case Manager with us:** + Excellent Orientation Program + Paid Time Off (PTO) +… more