- Alameda Health System (Oakland, CA)
- …to ad hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care . DUTIES & ESSENTIAL JOB FUNCTIONS: ... more
- LA Care Health Plan (Los Angeles, CA)
- …Skills Required: Knowledge of state, federal and regulatory requirements in Appeals / Care /Case/Utilization Management /Quality. Strong verbal and written ... more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for ... more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …This position is eligible for the eWorker persona.The TeamAs an integral part of the Clinical Appeals team, the Appeals Nurse Reviewer will serve as a ... more
- VNS Health (Manhattan, NY)
- …state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care ... more
- Molina Healthcare (Columbus, OH)
- …be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides ... more
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse** , you will help our hospital ... more
- Intermountain Health (Columbus, OH)
- …clinical support for appeals if needed. 4. Collaborates with Care Management , Utilization Review, Physician Advisors, Revenue Integrity, Compliance, Legal ... more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... more
- St. Luke's Health System (Twin Falls, ID)
- …a great place to work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist 2, is responsible for managing client medical denials ... more
- VNS Health (Manhattan, NY)
- …opportunities What You Will Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & ... more
- LA Care Health Plan (Los Angeles, CA)
- …Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... more
- University of Michigan (Ann Arbor, MI)
- …They collaborate with many departments outside of Revenue Cycle including Care Management , Registration, MiVisit Business services, clinics and ancillary ... more
- Catholic Health Services (Melville, NY)
- …timely follow through. | Reviews providers' requests for services and coordinates utilization/ appeals management review. | Assist Utilization and Appeals ... more
- Healthfirst (AL)
- …Preferred Qualifications: + Bachelors degree + Case management / care management -QOC experience preferred + Experience in clinical practice with ... more
- Catholic Health Services (Melville, NY)
- …from the Managed Care Department and applies to UM and appeals management processes. Works collaboratively with physicians, physician office staff and ... more
- Catholic Health Services (Melville, NY)
- …from the Managed Care Department and applies to UM and appeals management processes. |Works collaboratively with physicians, physician office staff and ... more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Appeals Specialist II, under the direction of the Director of Denial Support Services, logs and reviews per documentation guidelines for report ... more
- ManpowerGroup (Columbia, SC)
- …industry, is seeking an Analyst, Appeals to join their team. As an Analyst, Appeals , you will be part of the clinical review department supporting the ... more
- CVS Health (Hartford, CT)
- … system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. **This is a ... more
