- 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
- 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
- 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 (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
- 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
- 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
- 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
- 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
- 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
- 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)
- …- 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 (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
- 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
- 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
- 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
- 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
- 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 (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