- 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
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews ... payors for additional clinical documentation. | Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… more
- 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
- 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 (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
- 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
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE: The… more
- Beth Israel Lahey Health (Charlestown, MA)
- …taking a job, you're making a difference in people's lives.** Reporting to the Manager , Patient Financial Services, the Clinical Analyst plays an important role in a ... high-profile team tasked with handling all commercial and government clinical appeals and audit processes. The Clinical Analyst will perform high level clinical… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Manager of Utilization Review oversees a team of utilization review nurses and coordinators, ensuring compliance with clinical regulatory ... manager supports and coordinates the various aspects of the hospital's utilization management program, denials and appeals activities. Works with UR… more
- 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
- 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 e. Target DRGs Reviews f. Use of case manager as a resource + Uses guidelines to evaluate...e. Provides professional support to the functions within the Utilization Management Department f. Provides periodic written… more
- 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
- 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
- Hackensack Meridian Health (Neptune, 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 (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
- Molina Healthcare (Columbus, OH)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Baylor Scott & White Health (Dallas, TX)
- …**ESSENTIAL FUNCTIONS OF THE ROLE** + Functions as a working Supervisor for Utilization Review Department , through the monitoring of staff workload, creating ... **JOB SUMMARY** The Supervisor Utilization Review RN is accountable for daily oversight...assignments, reviewing productivity, conducting quality reviews, advising with peer-to-peer appeals , and advising with denial research. + Compiles data… 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** The Case Manager (CM) will be responsible for all aspects...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- City and County of San Francisco (San Francisco, CA)
- The Department of Public Health prioritizes equitable and inclusive access to quality healthcare for its community and values the importance of diversity in its ... workforce. All employees at the Department of Public Health work to advance equity, inclusion, and diversity with a specific lens and focus on race, ethnicity,… more
- Whidbey General Hospital (Coupeville, WA)
- …home health, Hospice, skilled nursing, anti-biotic regime, etc. The RN - Care Manager follows the hospital's Case Management/ Utilization Plan that integrates the ... JOB SUMMARY The RN - Care Manager is a health care professional with experience...indicators including LOS, cost per case, avoidable days, resource utilization , readmission rates, concurrent denials, and appeals .… more
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