• Manager , Grievance and Appeals , RN

    VNS Health (Manhattan, NY)
    …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals (RN)to lead the daily operations of our ... more
    VNS Health (03/05/25)
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  • Clinical Appeals Supervisor (Hybrid)

    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 ... more
    CareFirst (03/04/25)
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  • Appeals & Grievances Coordinator

    Point32Health (Canton, MA)
    …data entry and documentation requirements in multiple systems. + Escalates issues to Manager , Supervisors, and Case Manager Supervisors as needed to ... more
    Point32Health (03/08/25)
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  • Denial and Appeals RN / Clinical Resource…

    Hartford HealthCare (Wethersfield, CT)
    …Registration:_*Current State of Connecticut RN license is required. CCM (certified case manager ), CPUM (certified professional in utilization management), or ... more
    Hartford HealthCare (03/08/25)
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  • Quality Management Appeals and Grievances…

    UCLA Health (Los Angeles, CA)
    …NCQA, State and Federal regulations with direction from the Medical Director and QM Manager . + Review all member appeals and grievances for accuracy, ensuring ... more
    UCLA Health (03/04/25)
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  • Appeals and Grievances Quality Auditor

    Point32Health (MA)
    …members, partners, colleagues and communities. **Job Summary** Under the direction of the A&G Manager , the Appeals & Grievances QA Auditor audits the quality of ... more
    Point32Health (03/08/25)
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  • Supervisor, Appeals & Grievances

    Point32Health (MA)
    …colleagues and communities. **Job Summary** SUMMARY Under the general direction of the Senior Manager of Appeals and Grievances the Appeals and Grievance ... more
    Point32Health (03/14/25)
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  • Supervisor, Appeals and Grievances Clinical…

    LA Care Health Plan (Los Angeles, CA)
    …Required: Knowledge of state, federal and regulatory requirements in Appeals /Care/ Case /Utilization Management/Quality. Strong verbal and written communication ... more
    LA Care Health Plan (03/20/25)
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  • Assistant Attorney 1/ Assistant Attorney 2/…

    New York State Civil Service (Melville, NY)
    …by the Workers' Compensation Law;* Assisting in the assignment of cases when the Appeals Unit Manager is absent for extended periods;* Assisting the Legal ... more
    New York State Civil Service (01/09/25)
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  • Clinical Appeals Nurse (RN): Texas and New…

    Molina Healthcare (Columbus, OH)
    …unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified ... more
    Molina Healthcare (02/09/25)
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  • Audit & Reimbursement Senior- Appeals

    Elevance Health (Columbus, OH)
    …Able to work independently on assignments and under minimal guidance from the manager . + Prepare detailed work papers and present findings in accordance with ... more
    Elevance Health (03/20/25)
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  • Audit & Reimbursement III- Appeals

    Elevance Health (Columbus, OH)
    …Able to work independently on assignments and under minimal guidance from the manager . + Prepare detailed work papers and present findings in accordance with ... more
    Elevance Health (03/19/25)
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  • RN/ Case Manager -MSH- Case

    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 ... more
    Mount Sinai Health System (03/04/25)
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  • Case Manager RN

    HCA Healthcare (Rochester, NH)
    …for life - and empowers their passion for patient care. Apply today for our Case Manager opportunity. **Job Summary and Qualifications** The Case Manager ... more
    HCA Healthcare (02/06/25)
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  • Staff Nurse- Case Manager - Mount…

    Mount Sinai Health System (New York, NY)
    **Job Description** The Case Manager is responsible for all aspects of case management/ utilization review for an assigned group of inpatients, ED patients ... more
    Mount Sinai Health System (01/15/25)
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  • ED Case Manager RN- Mount Sinai…

    Mount Sinai Health System (New York, NY)
    **Job Description** The Case Manager (CM) will be responsible for all aspects of case management for an assigned group of inpatients to determine the ... more
    Mount Sinai Health System (03/04/25)
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  • RN Case Manager : University…

    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 ... more
    University of Michigan (03/04/25)
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  • Manager - Case Management and Social…

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible for functional and operational aspects of the Case Mgmt./Social Work ... more
    Houston Methodist (03/11/25)
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  • RN Case Manager I - Sharp Memorial…

    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); ... more
    Sharp HealthCare (02/23/25)
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  • Case Manager (CM) - RN or LCSW - FT…

    Select Medical (Los Angeles, CA)
    …partnership between Cedars-Sinai, UCLA Health and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) - 8 hr shifts Registered ... more
    Select Medical (03/04/25)
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