- UNC Health (Chapel Hill, NC)
- …communities we serve.RN Utilization Manager position specifically for a Utilization Manager/Clinical Appeals Nurse. This person is based at the Hedrick building and ... Enters all pertinent review data into the correct computer system in a timely manner. Consults with Physician Advisor...is a State position employed by UNC Health Care System . Qualified applicants will be considered without regard to… more
- The University of Vermont Health Network (Elizabethtown, NY)
- …of the organization. The manager is responsible for coordinating with system hospitals for admission referrals. Qualifications / Job Requirements:Education / Skills ... guidelines, and quality issues related to utilization management with application for appeals and denials management. * Knowledge of team/small group principles and… 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
- Fallon Health (Worcester, MA)
- …purpose** : Responsible for the coordination and timely completion of provider appeals . Serves as a liaison between Fallon Health and contracted and non-contracted ... providers with appeals regarding filing limit appeals , claim denials,...the documented process. + Ability to review correspondence and system data to establish facts and draw valid conclusions… 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)
- 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
- 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
- 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
- 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
- Elevance Health (Costa Mesa, CA)
- **Nurse Appeals - Licensed Nurse** **Location:** *The ideal candidate must reside in the state of California and live within 50 miles of our Woodland Hills Pulse ... Monday to Friday from 8:00-5:00 pm PT The **Nurse Appeals ** is responsible for investigating and processing and medical...+ Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems . + Generates written… 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
- 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
- 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
- Centene Corporation (Tallahassee, FL)
- …be considered for the role. **Position Purpose:** Facilitate medical necessity appeals and denials including disposition of denials notification letters, review of ... provider in accordance with company policies and NCQA guidelines. Create system authorization events for overturned denial decisions + Request additional… 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
- Internal Revenue Service (Fresno, CA)
- …CAREERS? Visit us on the web at www.jobs.irs.gov Responsibilities WHAT IS THE APPEALS DIVISION? A description of the business units can be found at: ... Vacancies will be filled in the following specialty areas: Office of Appeals Case and Operations Support Account and Processing Support Special Programs AARS… more
