- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and ... to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and...work. On the job or formal training in certified case management, denial and appeals management from… more
- CareFirst (Baltimore, MD)
- …- State Licensure And/or Compact State Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred or + LNCC - Legal Nurse Consultant ... goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance...Science Nursing or related field, Legal Nurse Consultant, Certified Case Manager . **Knowledge, Skills and Abilities (KSAs)**… more
- CareFirst (Baltimore, MD)
- …- State Licensure And/or Compact State Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred + LNCC - Legal Nurse Consultant Certified ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding… more
- University of Washington (Seattle, WA)
- …utilization review (or utilization management or healthcare management), certified case manager , certified documentation specialist, certified coder, certified ... Patient Financial Services Department** has an outstanding opportunity for a **Clinical Appeals and Disputes Nurse.** **WORK SCHEDULE** + 100% FTE + 100% Remote… more
- Elevance Health (FL)
- ** Appeals Medical Director - Medicare** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... is granted as required by law. Alternate locations may be considered. The ** Appeals Medical Director** is responsible for the appeal reviews for physical health… more
- Elevance Health (Nashville, TN)
- **Audit & Reimbursement II- Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... Perform cost report reopenings. + Under guided supervision, participate in completing appeals related work: + Position papers + Jurisdictional Reviews + Maintaining… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **RN/ Case Manager MSH Case Management PT Days** The Case Manager (CM) will be responsible for all aspects of case management ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as… more
- University of Michigan (Ann Arbor, MI)
- RN CASE MANAGER : University Hospital (Care Management) Apply Now **Job Summary** The RN Case Manager assesses, develops, implements, coordinates and ... effective utilization of resources while promoting quality outcomes. **Organizational Relationships** The RN Case Manager reports directly to the Manager of… more
- Sharp HealthCare (San Diego, CA)
- …Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Accredited Case Manager (ACM) - American Case Management Association (ACMA); ... Bachelor's Degree in Nursing; Master's Degree; Certified Case Manager (CCM) - Commission for ...Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers.Review all cases with readmission… more
- Sharp HealthCare (San Diego, CA)
- …**Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager ... Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) - American Case...Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers.Review all cases with readmission… more
- University of Southern California (Arcadia, CA)
- …and maintain BLS certification. Preferred (Not required) Professional certification as a case manager preferred. Pay Transparency The hourly rate range for ... POSITION SUMMARY The purpose of the Case Coordinator position is to support the physician..., excess days, resource utilization, readmission rates, denials, and appeals . + Collaborates and communicates with multidisciplinary team in… more
- Highmark Health (Monroeville, PA)
- …BSN **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association - ... + Case Management - American Board of Occupational Health Nurses (ABOHN) andCertified Case Manager (CCM) + Commission for Case Manager Certification… more
- International Medical Group (Indianapolis, IN)
- …visa status (eg, H-1B or TN status) for this position. JOB SUMMARY The Case Manager will evaluate medical necessity, appropriateness, and efficiency of the use ... outpatient management of assistance cases. + Knowledge of the Non-certification process and Appeals process including logs and time frames. + Participate in the on… more
- Elevance Health (Gary, IN)
- **LTSS Service Coordinator ( Case Manager )** **Location:** Seeking candidates located in Lake County Indiana. **_Please note that per our policy on hybrid/virtual ... to client needs, and direct, hands-on engagement. The **LTSS Service Coordinator ( Case Manager )** is responsible for conducting service coordination functions… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Care Advocacy Case Manager RN - Bilingual Spanish Location: Remote Career Area: Health ... of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and tools. Care Advocacy… more
- NHS Management, LLC (Tuscaloosa, AL)
- Job Description Regional MDS Case Manager $10k sign on bonus + company car! MDS (minimum data set) experience required. RAC certified highly desired! Are you a ... advance your career? NHS is seeking an experienced MDS Case Manager to add to our team...and Rehabilitation in gathering information for Medicare and Medicaid appeals and denials as requested. + During facility visits,… more
- Elevance Health (Gallipolis, OH)
- **LTSS Service Coordinator ( Case Manager )** **Candidates should live in one of the following counties:** Auglaize, Coshocton, Defiance, Gallia, Harrison, Holmes, ... + Assists and participates in appeal or fair hearings, member grievances, appeals , and state audits. **Minimum Requirements:** + Requires BA/BS degree and a… more
- Trinity Health (Philadelphia, PA)
- …a member of Trinity Health Mid-Atlantic, is seeking an experienced RN Care Manager to join our team in the Emergency Department! **Schedule:** Full-time - Day ... supervision of the Director of Care Coordination, the Emergency Department Care Manager assists physicians and the interdisciplinary team in facilitating the entry… more
- Bozeman Health (Bozeman, MT)
- …the claims denial process for insurance carriers and develops an appropriate appeals response as necessary. Minimum Qualifications: Required + High School diploma ... Previous ICD-10 and CPT coding + Previous experience in medical pre-authorization, case management and / or financial counseling Essential Job Functions: In addition… more
- Cardinal Health (Cheyenne, WY)
- …insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed + Resolve patient's questions and any representative ... for the patient's concerns regarding status of their request for assistance + Demonstrate expertise in payer landscapes and insurance processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare,… more
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