- CareFirst (Baltimore, MD)
- …programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Appeals and Analysis **Equal Employment Opportunity** ... all lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State...who is willing and able to work in a hybrid model. The incumbent will be expected to work… more
- Elevance Health (Columbus, OH)
- ** Manager I - Grievances & Appeals ...clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and ... Provider Disputes** **Location** : This position will work a hybrid model (in office 1-2 days per week). The...Maine, Missouri, Virginia, Indiana, Kentucky or New York. The ** Manager I - Grievances & Appeals ** is… more
- Elevance Health (Bon Air, VA)
- …responsible to review, analyze and process pre service and post service grievances and appeals requests related to clinical and non clinical services, ... **Title: Grievance/ Appeals Analyst Lead** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of… more
- Elevance Health (Columbus, GA)
- **Title: Grievance/ Appeals Analyst 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 Analyst I** is an entry level position in...HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of… more
- Elevance Health (Los Angeles, CA)
- **Title: Grievance/ Appeals Analyst 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 Analyst I** is an entry level position in...HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of… more
- Elevance Health (Richmond, VA)
- **Title: Grievance/ Appeals Analyst II** **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 Analyst II** will be responsible for reviewing, analyzing...HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of… more
- Elevance Health (Rancho Cordova, CA)
- **Nurse Appeals - Licensed RN Nurse** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the state of ... Monday to Friday from 8:00-5:00 pm PT The **Nurse Appeals ** is responsible for investigating and processing medical necessity.../grievances/quality of care issues and is a resource for clinical and non clinical team members in… more
- Elevance Health (Atlanta, GA)
- **Medical Director- Appeals (Primary Care-IM or FM)** **Location: This is a hybrid position. Candidates must live within 50 miles of an Elevance Health ... programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- CareOregon (Portland, OR)
- …Requisition #: 24590 Department: Department: Medical Management Administration Title of Manager : Sr Medical Director - Clinical Services Supervises: ... full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes: Posting Notes: This is a hybrid position that will include travel to the Portland office… more
- Elevance Health (Chicago, IL)
- **Sign-on Bonus:** $10,000 The ** Clinical Operations Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent ... locations. **How you will make an impact:** + Ensures timely completion of clinical case reviews for their board certified specialty. + Makes physician to physician… more
- University of Michigan (Ann Arbor, MI)
- …organizational policies, OIG guidelines, and other applicable regulations. Overall, the manager utilizes project management skills, clinical knowledge and ... REVENUE CYCLE CODING MANAGER - CODING QUALITY/EDUCATION Apply Now **Job Summary**...Compliance Specialists (MCCS), The PB Denials Team, and the Appeals and Denial Coordinators. These professionals support coding compliance,… more
- University of Michigan (Ann Arbor, MI)
- RN CASE MANAGER : University Hospital (Care Management) Apply Now **Job Summary** The RN Case Manager assesses, develops, implements, coordinates and monitors a ... care areas. The position is unique in that it combines clinical /quality considerations with regulatory/financial/utilization review demands. The position creates a… more
- Elevance Health (San Juan, PR)
- …providing information technology and business operations services for health plans._ ** Manager I Medical Management** **Location:** This position will work a ... hybrid model (1-2 days/week onsite in office). When reporting...time zones that the unit will be supporting. The ** Manager I Medical Management** is responsible to manage a… more
- Elevance Health (Kansas City, KS)
- …+ Uses tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for ... member's cases (serving as the single point of contact) with the clinical healthcare management and interdisciplinary team in order to provide care coordination… more
- State of Colorado (Denver, CO)
- …Work Address 710 S. Ash Street, Unit C140, Denver, CO 80246 - Hybrid working arrangements FLSA Status Exempt; position is not eligible for overtime compensation. ... Please see the Supplemental Information section below for details! Description of Job Hybrid . Predominantly telework with a minimum of one in-person meeting a month.… more
- International Medical Group (Indianapolis, IN)
- …-- Must have an active RN license in good standing in Indiana. + Location: Hybrid or Remote working options. + Corporate office is in Indianapolis, IN. + Relocation ... status (eg, H-1B or TN status) for this position. JOB SUMMARY The Case Manager will evaluate medical necessity, appropriateness, and efficiency of the use of health… more
- Centene Corporation (Springfield, IL)
- …to document, investigate and resolve formal or informal complaints and appeals in accordance with Company and State policies, procedures and requirements. ... degree in related field or equivalent experience. 3+ years clinical , quality management or healthcare related experience and 1...holidays, and a flexible approach to work with remote, hybrid , field or office work schedules. Actual pay will… more
- University of Michigan (Ann Arbor, MI)
- …coordinate all activities related to the response to external audit activities, appeals , and denials. Work with stakeholders to create proactive systems that will ... activities are performed independently but in consultation with the Senior Manager . **What You'll Do** **LEADERSHIP** Provide leadership for the Birth Certificate… more
- AmeriHealth Caritas (Newark, DE)
- …leadership in the operational areas of care management, utilization review, appeals , quality improvement and related policy and practice initiatives in collaboration ... throughout the provider network. + Overseeing the quality of clinical care for network and non-network providers. + Engaging...associates and Providers. + Serves as medical advisor and manager for all clinically related activities. + Assures that… more
- VNS Health (Manhattan, NY)
- …recovery goals at the forefront of all initiatives. This position is hybrid . Compensation Range:$137,800.00 - $229,700.00 Annual Along with our highly competitive ... base pay, we offer pay differentials based on education, clinical experience, certifications, and work in high need areas....the VNS Health Social Services Community of Professionals + Hybrid (about 2 days per week in the office)… more