- Elevance Health (Miami, FL)
- …records. Under guided supervision, participate in completing more complex appeals related work: Position papers Jurisdictional Reviews Maintaining accurate records ... by updating all logs, case files, tracking systems Participate in all team meetings,...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Mount Sinai Health System (New York, NY)
- Job Description RN/ Case Manager MSH Case Management FT Days The Case Manager (CM) will be responsible for all aspects of case management for an ... term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager or...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as… more
- NTT America, Inc. (Plano, TX)
- …adaptable, and forward-thinking organization, apply now. We are currently seeking a Delivery Senior Manager to join our team. NTT DATA is seeking to hire a Medicare ... Appeals Clinical Leader to lead service delivery engagements and...regarding performance, metrics, and processes. Track appeal metrics, including case volumes, resolution times, and denial rates. Analyze processes… more
- Ralliant (Indianapolis, IN)
- Job Title: Product Manager Location: Remote, USA Job Summary: As a key contributor within Hengstler-Dynapar, the Product Manager will guide the strategic vision ... aligns with the company's business objectives while collaborating cross-functionally. The Product Manager will work closely with all functions within our company to… more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Manager Revenue Cycle position is responsible for the daily management of the staff and operations for one or more of the following areas ... to: medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This… more
- Dignity Health (Phoenix, AZ)
- Job Summary and Responsibilities As the Manager of Philanthropy, you will develop, implement, and manage strategies to cultivate, solicit, and steward annual donors, ... for our mission. Every day you will oversee direct mail, email appeals , online giving, and donor communication, ensuring compelling messaging and effective… more
- Community Health Systems (Franklin, TN)
- …- Registered Nurse - State Licensure and/or Compact State Licensure required CCM - Certified Case Manager preferred or Accredited Case Manager (ACM) ... role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient… more
- Community Health Systems (Franklin, TN)
- …and effective management of utilization review processes, including denials and appeals activities. This role collaborates with payers, hospital staff, and clinical ... input from the Utilization Review Clinical Specialist. Monitors and updates case management software with documentation of escalations, avoidable days, authorization… more
- Rush University Medical Center (Chicago, IL)
- …Coordinates post discharge care transition referral communication. In collaboration with the case manager , provides referral and follow-up contacts to agencies, ... be offered for the position. Offers may vary depending on the circumstances of each case . Summary: The Care Management Navigator I is part of a care management team… more
- Rush University Medical Center (Chicago, IL)
- …for the position. Offers may vary depending on the circumstances of each case . Summary: Responsible for assisting the Denial Management team with various duties ... Care payers and submit charts when needed with these appeals . Works with Rush University Medical Center and Rush...for resolution of escalated issues internally. Escalates issues to manager or payers as needed. Documents activity in all… more
- Guardian Life (Harrisburg, PA)
- …with Group Disability claims experience to join our dynamic Appeals Team. The ** Appeals Case Manager II** (ACM 2) is responsible for adjudicating ... assigned appeals for Group Life and Disability claims. The ACM...Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals . You are A highly motivated and reliable individual… more
- 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
- Elevance Health (Indianapolis, IN)
- ** Appeals Medical Director - Indiana Medicaid** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... 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 (Los Angeles, CA)
- **Behavioral Health Medical** **Director-Psychiatrist** ** Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of ... clinical operational aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **RN/ Case Manager (Inpatient) Mount Sinai Morningside FT Days EOW** The Case Manager (CM) will be responsible for all aspects of ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals 15. Communicates clinical information to the payor, as… more
- MVP Health Care (Schenectady, NY)
- …innovative thinking and continuous improvement. To achieve this, we're looking for a ** Case Manager , Medicaid Long Term Support Program** to join #TeamMVP. If ... medically complex Medicaid members. + Through collaborative efforts the Case Manager will identify the medical and...maintain cost-effectiveness and manage Medical Loss Ratio (MLR). + Appeals & Denials: Participate in the appeals … 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
- Calvary Hospital (Bronx, NY)
- The RN Case Manager (RNCM) will be responsible for all aspects of case management for an assigned group of patients to determine the appropriateness of the ... Assessment and Performance Improvement activities of the Department of Case Management. Assesses, plans, coordinates, implements and evaluates patient's health… more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- …perspective and experience makes ConnectiveRx better than the sum of its parts. The Case Manager 's primary duty is to assist customers with chronic illnesses in ... by gaining access to their wellbeing needs, journey and treatment plan. The Case Manager collaborates and maintains consistent communications with internal and… more
- TEKsystems (Morrisville, NC)
- Reimbursement Case Manager - Onsite Training, Remote After Start Date: December 15, 2025 Contract Length: 3 months Pay Rate: $20/hr Schedule: 8:00 AM - 5:00 PM ... United States Work Arrangement: Onsite for training, remoteafter Role Overview The Reimbursement Case Manager (RCM) will act as a subject matter expert on… more
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