• Appeals Manager , Department

    BronxCare Health System (Bronx, NY)
    …Management Position Type Regular Full-Time Division Bronxcare- Yonkers Max USD $97,125.00/Yr. Shift Day Shift Department : Name Appeals Department (BHCS) ... 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… more
    BronxCare Health System (09/18/24)
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  • Manager , Grievance and Appeals , RN

    VNS Health (Manhattan, NY)
    …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals (RN)to lead the daily operations of our ... management of clinical appeals review processes within Appeals & Grievances Department . + Manages the...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… more
    VNS Health (09/04/24)
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  • Clinical Appeals Manager - RN…

    CareFirst (Baltimore, MD)
    …membership, and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department . We are looking for an experienced people ... + Master's in Science Nursing or related field, Legal Nurse Consultant, Utilization Management, and Government Program experience with Appeals and Grievance,… more
    CareFirst (11/09/24)
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  • Clinical Appeals Supervisor - RN (Hybrid)

    CareFirst (Baltimore, MD)
    …educational and training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in the development and ... **Preferred Qualifications:** + BS/MSN Degree. + 3 years supervisory experience Utilization Management, and Government Program experience with Appeals and… more
    CareFirst (11/09/24)
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  • Grievance/ Appeals Analyst I (US)

    Elevance Health (Indianapolis, IN)
    … Analyst I** is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post ... **Title: Grievance/ Appeals Analyst I** **Location:** This position will work...requirements. + As such, the analyst will strictly follow department guidelines and tools to conduct their reviews. +… more
    Elevance Health (10/29/24)
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  • Grievance/ Appeals Analyst I (California…

    Elevance Health (Los Angeles, CA)
    … Analyst I** is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post ... **Title: Grievance/ Appeals Analyst I** **Location:** This position will work...requirements. + As such, the analyst will strictly follow department guidelines and tools to conduct their reviews. +… more
    Elevance Health (10/11/24)
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  • Supervisor, Appeals and Grievances Clinical…

    LA Care Health Plan (Los Angeles, CA)
    Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department : CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... Required: Knowledge of state, federal and regulatory requirements in Appeals /Care/Case/ Utilization Management/Quality. Strong verbal and written communication… more
    LA Care Health Plan (09/20/24)
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  • Clinical Appeals Nurse (Remote)

    CareFirst (Baltimore, MD)
    …+ Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation...Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred + LNCC - Legal Nurse… more
    CareFirst (11/09/24)
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  • Denials and Appeals Nurse- Full Time

    Dayton Children's Hospital (Dayton, OH)
    …- OhioDepartment: Utilization Review TeamSchedule:Full timeHours:40Job Details:Reporting to the Manager of Utilization Management and in partnership with the ... below, may also be assigned other duties as required. Department Specific Job Details: Education + Completion of accredited...in a hospital required + 3-5 years as progressive utilization review nurse and knowledge of payers and managed… more
    Dayton Children's Hospital (11/05/24)
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  • Manager , Utilization Management RN…

    Providence (Mission Hills, CA)
    …Southern California Region. The Manager assists the Regional Director of Utilization Management, Appeals & Clinical Training through the provision of ongoing ... **Description** The Manager of Utilization Management provides a...5 years Healthcare management experience related to acute care utilization management or appeals management. **Preferred Qualifications:**… more
    Providence (11/04/24)
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  • Utilization Review Nurse Coordinator (40…

    State of Connecticut, Department of Administrative Services (East Hartford, CT)
    Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 241106-5613FP-001 Location East Hartford, CT Date Opened 11/7/2024 12:00:00 AM Salary ... + + Introduction The State of Connecticut (https://portal.ct.gov/) , Department of Developmental Services (DDS (https://portal.ct.gov/dds?language=en\_US) ) - North… more
    State of Connecticut, Department of Administrative Services (11/07/24)
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  • Utilization Review Manager -Selikoff…

    Mount Sinai Health System (New York, NY)
    **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
    Mount Sinai Health System (10/31/24)
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  • Utilization Review Physician Full Time

    Hackensack Meridian Health (Hackensack, NJ)
    …- OBS vs. Inpatient** **c. Liaison to the Medical Staff supporting Utilization Management Committee processes** **d. Hospital Based Appeals Management** **e. ... based** **medicine** **e. Provides professional support to the functions within the Utilization Management Department ** **f. Provides periodic written and verbal… more
    Hackensack Meridian Health (11/02/24)
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  • Physician Utilization Review Specialist Per…

    Hackensack Meridian Health (Hackensack, NJ)
    …determinations - OBS vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based Appeals Management e. ... documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate...e. Provides professional support to the functions within the Utilization Management Department f. Provides periodic written… more
    Hackensack Meridian Health (08/19/24)
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  • Manager Utilization Management

    Corewell Health (Grand Rapids, MI)
    …upgrades, provider appeals and auditing and overall outcomes of the department . Essential Functions + Provides operational management over the department ... Primary Location SITE - Priority Health - 1231 E Beltline - Grand Rapids Department Name PH - Inpatient Utilization Management Employment Type Full time Shift… more
    Corewell Health (11/01/24)
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  • Mgr - Utilization Review - SMRMC…

    Prime Healthcare (Reno, NV)
    …as defined by the Hospital/ Department and obtain the Certified Case Manager credential. 1+ year of utilization review experience is highly preferred. 7. ... of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities Utilization Review Manager is responsible for the… more
    Prime Healthcare (11/08/24)
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  • Utilization Review RN

    Billings Clinic (Billings, MT)
    …80 hours (Non-Exempt) Starting Wage DOE: $35.34 - 44.18 Under the direction of department leadership, the Utilization Review/ Management RN. This position is to ... cases that require second level review to Physician Advisor, Manager , and Director per department process or...to department leadership and Physician Advisor, per department process or procedure Insurance and Utilization more
    Billings Clinic (11/05/24)
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  • Market Director Utilization Management

    Catholic Health Initiatives (Lexington, KY)
    …in support of the CommonSpirit Health Care Coordination model. The Utilization Management department processes authorizations, inpatient admission and continued ... inside our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director is responsible for the market(s) development,… more
    Catholic Health Initiatives (09/19/24)
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  • RN- Utilization Management

    ERP International (Nellis AFB, NV)
    **Overview** ERP International is seeking **Registered Nurse (RN) Utilization Managers** for full-time positions in support of theMike O'Callaghan Military Medical ... No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality Improvement… more
    ERP International (11/02/24)
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  • Care Coordinator, Utilization Management

    Hackensack Meridian Health (Holmdel, NJ)
    …information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains ... healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for… more
    Hackensack Meridian Health (10/24/24)
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