- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and ... to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials… more
- CareFirst (Baltimore, MD)
- …+ Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used ... goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance...response to regulatory complaints and/or to assist the Legal Department in preparation for legal disputes including attending and… more
- University of Washington (Seattle, WA)
- …Financial Services Department ** has an outstanding opportunity for a **Clinical Appeals and Disputes Nurse.** **WORK SCHEDULE** + 100% FTE + 100% Remote + ... Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared...auditor, certified professional in utilization review (or utilization management or healthcare management), certified case manager… more
- 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
- Huron Consulting Group (Chicago, IL)
- …our team as the expert you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, and ... Review Plan and the overall operation of the Utilization Management Department in accordance with federal,...Performance Tracking and Improvement: Provides analysis and reports of utilization , denials, and appeals KPIs, trends, patterns,… more
- Children's Mercy Kansas City (Kansas City, MO)
- …review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital performance ... to integrated inpatient teams; assists Director in the management of department ; including personnel and fiscal management and development of, and training… more
- Sanford Health (Rapid City, SD)
- …time **Weekly Hours:** 40.00 ** Department Details** Join our team as a Utilization Review and Case Management Manager and lead a high-impact, data-driven ... value across the care continuum. You'll shape and execute utilization strategies that become the standard for how we...Summary** Responsible for the day to day oversight of department function both in terms of provision of service… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... services to ensure compliance with utilization management policies. This role conducts admission and continued stay reviews, supports denials and appeals … more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse I Department : Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time) Schedule: Monday - ... as needed. Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a resource on denial management as… more
- University of Utah Health (Salt Lake City, UT)
- …**Workplace Set Up** _Hybrid_ **_City_** _Salt Lake City_ **_State_** _UT_ ** Department ** _UUH CST 27N Utilization Review_ **Category** _Nursing_ **Workplace ... advancement, and overall patient outcomes. **Responsibilities** + Applies approved utilization criteria to monitor appropriateness of admissions with associated… more
- Community Health Systems (Franklin, TN)
- … Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals activities. This ... timely authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities, assists… more
- Healthfirst (NY)
- …and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead ... including but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions + Partner… more
- Saint Francis Health System (Tulsa, OK)
- …a minimum number of worked hours per month as needed by the department ; limited benefit offerings. \#ALDIND Saturday and Sunday **This position will be submitting ... in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal… more
- Sharp HealthCare (San Diego, CA)
- **Facility:** Copley Drive **City** San Diego ** Department ** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Other; California ... care, SNF, home health, or hospice settings. + Experience as a case manager or discharge planner interacting with managed care payers. + Experience with InterQual… more
- Sharp HealthCare (San Diego, CA)
- …the discharge.He/she documents as appropriate in the EMR and provides information to the department head as indicated. + Utilization review and utilization ... **Facility:** Sharp Memorial Hospital **City** San Diego ** Department ** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time**… more
- Mount Sinai Health System (New York, NY)
- …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years experience as a ... **Job Description** **RN/Case Manager MSH Case Management PT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Sharp HealthCare (San Diego, CA)
- …documents as appropriate in the electronic medical record and provides information to the department head as indicated. + Utilization review and utilization ... **Facility:** Sharp Memorial Hospital **City** San Diego ** Department ** **Job Status** Regular **Shift** Day **FTE** 1...1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager … more
- University of Michigan (Ann Arbor, MI)
- …to develop and implement a comprehensive, integrated discharge plan from the emergency department (ED). The RN Case Manager will recommend and document patient ... RN CASE MANAGER : University Hospital (Care Management) Apply Now **Job...of the interdisciplinary team in the inpatient and emergency department patient care areas. The position is unique in… more
- Guthrie (Sayre, PA)
- Summary The Denial, Appeal, and Audit Manager is responsible for the oversight and management of all payer denials, appeals , and audit processes within the ... of claim denials, effective appeal strategies, and proactive audit response. The manager leads a team of specialists, coordinates with internal departments, and… more
- Trinity Health (Philadelphia, PA)
- …experienced RN Care Manager to join our team in the Emergency Department ! **Schedule:** Full-time - Day Shift, 10-hour shifts **:** Under the general supervision ... of the Director of Care Coordination, the Emergency Department Care Manager assists physicians and the interdisciplinary team in facilitating the entry of… more
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