- Apex Health Solutions (Houston, TX)
- …and grievances. This associate may screen incoming complaints, process medical necessity, utilization management and claims appeals , initiate Independent ... Job Title: Appeals & Grievances Coordinator Department: ...a daily basis with the Customer Service Department, Medical Management Department, Medical Directors, enrollees, providers and TPA Staff… more
- Apex Health Solutions (Houston, TX)
- …and grievances. This associate may screen incoming complaints, process medical necessity, utilization management and claims appeals , initiate Independent ... Summary: The Appeals and Grievances coordinator , Senior position,...a daily basis with the Customer Service Department, Medical Management Department, Medical Directors, enrollees, providers and TPA Staff… more
- CVS Health (Frankfort, KY)
- …service or audit experience. Experience in research and analysis of utilization management systems. **Preferred Qualifications** Knowledge in Word, MedHOK, ... customer service or audit experience. Experience in research and analysis of utilization management systems. Associate's degree or equivalent experience **Pay… more
- University of Virginia (Haymarket, VA)
- …hospital or ambulatory clinic environment dealing with payors in a Utilization /Case Management /Pre-Arrival role where prior authorizations, prior certifications, ... + Follow the appropriate payor procedures for initiating reviews, reconsiderations and/or appeals . + Follow-up with the payors to assure our requests are responded… more
- Hackensack Meridian Health (Neptune, NJ)
- …and serve as a leader of positive change. The **Care Management , Care Coordinator , Utilization Management ** is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Holmdel, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The **Care Coordinator , Utilization Management ** is a member of the healthcare team ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… 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 ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=)… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Case Management (CM) Coordinator position is a proficient CM representative that provides technical, clerical and data management ... benefits and post-acute care needs. + Streamlines concurrent insurance denials and/or appeals process, in collaboration with management and nursing staff.… more
- Corewell Health (Taylor, MI)
- …of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate ... Care Coordinator for Rehab Services PRN/Casual position- hours will...managing a case load of patients that includes facilitating utilization management , and/or care coordination during the… more
- State of Colorado (Lakewood, CO)
- Domestic Violence Program Coordinator (Administrator V) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4723215) Apply Domestic Violence ... Program Coordinator (Administrator V) Salary $89,520.00 - $143,256.00 Annually Location...workplace. CDPS is an equal opportunity employer. See ourEEOD Utilization Report (2020)Why Do I Love My Job at… more
- Elevance Health (Overland Park, KS)
- …(such as LTSS/IDD), behavioral health or physical health needs. + Submits utilization /authorization requests to utilization management with documentation ... to, potential for high-risk complications). + Engages the primary service coordinator and other clinical healthcare management and interdisciplinary teams… more
- State of Colorado (Broomfield County, CO)
- …Office Administrator and Fleet Coordinator Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4725757) Apply CDA-Commissioner's Office ... Administrator and Fleet Coordinator Salary $52,344.00 - $62,808.00 Annually Location Broomfield County,...with state administrative policies and procedures, facilities operations, fleet management , board and commission management , and general… more
- Elevance Health (Fort Lauderdale, FL)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... $5,000 Sign On Bonus **LTSS Service Coordinator ** _Location:_ This is primarily a field based...plan, engaging the member's circle of support and overall management of the individuals physical health (PH)/behavioral health (BH)/LTSS… more
- Elevance Health (Woodbridge, NJ)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... **LTSS Service Coordinator ** _Location:_ This is a hybrid role. Candidate...plan, engaging the member's circle of support and overall management of the individuals physical health (PH)/behavioral health (BH)/LTSS… more
- Mohawk Valley Health System (Utica, NY)
- Registered Nurse - MDS Coordinator - Regular Hours - Days Department: UTILIZATION SERVICES Job Summary The RN - MDS Coordinator will play a crucial role in ... of daily Medicare documentation and Medicare (re)certifications. + Initiates and monitors appeals to Livanta. + Prepares CMI (Case Mix Index) calculations and… more
- Nuvance Health (Poughkeepsie, NY)
- …for appeals , following processes established by the Health Information Management Department. 5. Assists in timely sorting and disseminating requests for medical ... *Description* Purpose: The Operations Coordinator , with a high degree of autonomy, will...execution of equipment procurement. 2. Runs and prepares Case Management reports and assists with creating presentations for monthly… more
- Virtua Health (Pennsauken, NJ)
- …work with other areas for best practice. Evaluate data reporting to committee/ management on a regular basis. Within Utilization Review, provides administrative ... Hours: 40 Additional Locations: Job Information: This position to support Utilization Review revenue cycle. Summary: Provides guidance, support, and oversight to… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- ADMINISTRATIVE COORDINATOR 4 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4722511) Apply ADMINISTRATIVE COORDINATOR 4 Salary $2,602.00 ... of quality services, the development and stimulation of services of others, and the utilization of available resources in the most effective manner. LDH serves as a… more
- Providence (OR)
- …of Care Planning, Discharge Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization, Medical ... we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** + Support the commercial insurance based line of business… more
- Providence (Beaverton, OR)
- …of Care Planning, Discharge Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization, Medical ... we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Maternity / Pediatrics who will:** + Support the commercial insurance… more