- Insmed Incorporated (Denver, CO)
- …for patients battling serious and rare diseases. The Field Access Manager will leverage his/her reimbursement expertise and demonstrated experience to identify, ... products as prescribed by the HCP. The Field Access Manager will be a member of the field-based Field...HCP Educate HCP office staff about prior authorization & appeals process, how to access related forms, and high-level… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
- 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 ... to, Provider Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances. + Ensures… more
- CareFirst (Baltimore, MD)
- …State Licensure And/or Compact State Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred **Experience:** 5 years' Experience in a ... NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an...of the range, as compensation decisions depend on each case 's facts and circumstances, including but not limited to… 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 ... educational and training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in the development and… 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
- Conduent (Hamilton, NJ)
- …and Health Services (DMAHS) of New Jersey. **Reports To** This position reports to the Appeals Supervisor and the Appeals Manager . The Appeals ... a culture where individuality is noticed and valued every day. Fair Hearing Appeals Agent $18.50/ Hourly Onsite- Hamilton, NJ Full-time and Full Benefits **Location… more
- New York State Civil Service (Liverpool, 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 ... Attorney 1/ Assistant Attorney 2/ Assistant Attorney 3 / Senior Attorney - Appeals (NY HELPS) Occupational Category Legal Salary Grade NS Bargaining Unit PS&T -… more
- 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 ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category:...culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the A&G Leadership in… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE: The… 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 ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals + Communicates clinical information to the payor, as… more
- State of Colorado (Colorado Springs, CO)
- …/ Community Programs Specialist III (Treatment Coordinator Case Manager ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4730427) Apply ... CDOC / Community Programs Specialist III (Treatment Coordinator Case Manager ) Salary $4,809.00 - $7,695.00 Monthly...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- 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 ... and identify the expected length of stay (ELOS). The case manager works collaboratively with physicians, social...with physicians and managed care companies on concurrent denial appeals * Communicates clinical information to the payor, as… more
- 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 ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information to the payor, as… more
- State of Colorado (Denver, CO)
- Health Professional III- MHTL Home Intensive Case Manager Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4735643) Apply Health ... Professional III- MHTL Home Intensive Case Manager Salary $30.51 - $42.72 Hourly...Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel… 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); ... Case Manager (CCM) - Commission for Case Manager Certification; Bachelor's Degree in Nursing;...Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers.Review all cases with readmission… more
- Houston Methodist (Baytown, TX)
- At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible for functional and operational aspects of the Case Mgmt./Social Work ... corporate and hospital administrators, medical staff, and defined customers related to the Case Mgmt. system. The Manager Case Mgmt./Social Work position… more
- Select Medical (Los Angeles, CA)
- …Joint Venture with Cedars, UCLA and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse (RN) or Licensed ... at Cal Rehab have a high discharge to home rate. **Benefits of working as a Case Manager with us:** + Excellent Orientation Program + Paid Time Off (PTO) +… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Nursing Clinical Manager (NCM) for Case Management is responsible for the day to day management of the Case Managers. This includes, ... staffing, employee performance evaluation, performance improvement, and staff education. The NCM Manager serves as a resource/mentor for Case Managers, Social… more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- …at 30 days, $1000 due at 180 days. (bonus paid for 11:30-8pm shift only) The Case Manager 's primary duty is to assist customers with chronic illnesses in their ... territory by accessing their well-being needs, journey, and treatment plan. The Case Manager collaborates and maintains consistent communications with internal… more
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