- Banner Health (AZ)
- **Primary City/State:** Arizona, Arizona **Department Name:** Grievances & Appeals **Work Shift:** Day **Job Category:** General Operations The future is full of ... and skills to BPN. As a Senior Grievance & Appeals Coordinator you will call upon your years of... coordinators, capable of mentoring trainees through a "buddy system ". Skill in developing and managing teams; demonstrated critical… more
- ManpowerGroup (Durham, NC)
- **Title:** **Clinical Appeals Analyst** **Location: 4613 University Drive Durham NC 27707 United States (Onsite)** **Duration: 6+ months** **Pay rate: $41.75/hr (On ... W2)** **Job Description:** The Clinical Appeals Consultant is responsible for supporting the increased workload in the Claims Department, particularly due to an… more
- Martin's Point Health Care (Portland, ME)
- …Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational ... Place to Work" since 2015. Position Summary Job Description Position Summary: The Appeals Specialist (Medicare or US Family Health Plan) is responsible for ensuring… more
- CVS Health (Carson City, NV)
- …or audit experience. Experience in research and analysis of utilization management systems . Preferred Qualifications Knowledge of Fast Track Appeals and includes ... affordable. Position Summary Responsible for managing to resolution of Fast Track Appeals for Medicare products, which may contain multiple issues and, may require… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals … more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- The Mount Sinai Health System (New York, NY)
- …:** Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight ... and operations. **Strength Through Diversity** The Mount Sinai Health System believes that diversity, equity, and inclusion are key...actively as a part of the Mount Sinai Health System team by: + Using a lens of equity… more
- CVS Health (Hartford, CT)
- …opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their ... of this Medical Director role are related to Medicare Appeals .* Direct daily work on part C appeals...more years of experience in a Health Care Delivery System eg, Clinical Practice or Health Care Industry *… 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 ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...and certain positions in the Emergency Department). Alameda Health System is an equal opportunity employer and does not… more
- Trinity Health (Darby, PA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Appeals and Utilization Management Coordinator under direction and in collaboration with the ... RN Care Coordination Manager, provides support to the utilization management, denials and appeals process for the THMA South hospitals. The Appeals and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting… 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 ... to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible...requirements. Serves as a super-user on electronic programs and systems used by the department. Assists in the development… more
- Elevance Health (Knoxville, TN)
- **Nurse Appeals - Licensed Nurse** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live in the state of Tennessee or ... within 50 miles of one of our PulsePoint locations. The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals requests… more
- Iowa Department of Administrative Services (Des Moines, IA)
- Assistant Attorney General- Criminal Appeals Section Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/4519255) Assistant Attorney General- Criminal ... Appeals Section Salary $57,636.80 - $139,318.40 Annually Location Des...are proud to offer the Iowa Public Employees Retirement System (IPERS). A defined benefit plan, IPERS benefits are… more
- CareFirst (Owings Mills, 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 of member and provider disputes regarding… more
- Kepro (Indianapolis, IN)
- …in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job Summary: Our Utilization ... Management Appeals Nurse - LPN/RN will help orchestrate the seamless...Office: Excel, Outlook, PowerPoint, Word, and SharePoint) and job-specific applications/ systems to produce correspondence, charts, spreadsheets and/or other information… more
- Trinity Health (Farmington Hills, MI)
- …Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing ... of appeals as required by payers, in addition to promoting...staff and other MO colleagues, regarding denial management processes, systems and requirements. May provide clinical input to Pre-Service… more
- Molina Healthcare (Richmond, KY)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- About The Role The Appeals Manager is responsible managing Appeal Supervisors and identifying opportunities for enhancements and changes to workflows to increase ... + Effectively manage Appeal Supervisors, providing full-time support to appeals , internal departments, vendors, and customers. + Demonstrate strong leadership… more
- R1 RCM (Salt Lake City, UT)
- …solutions that transform the patient experience and financial performance of hospitals, health systems , and medical groups. We are the one company that combines the ... intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse** , you will help review and interpret...skills, experience, and relevant education or training. The healthcare system is always evolving - and it's up to… more