- Guardian Life (Bethlehem, 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)
- …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
- 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 ... 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
- Actalent (Los Angeles, CA)
- CALIFORNIA BASED REMOTE RN CASE MANAGER HIRING NOW!! A large... and Grievances senior RN will report to the Appeals and Grievances Manager . + In this ... wide healthcare network is looking for a REMOTE RN case manager to join their team on...shift) - 830am to 5pm. + The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing… 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 e. Communicates clinical information to the payor, as… 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
- 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); ... Nurse (RN) - CA Board of Registered Nursing; 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 (La Mesa, CA)
- …**Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Master's Degree; Accredited Case Manager (ACM) - American Case Management Association (ACMA); ... Bachelor's Degree in Nursing; 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
- 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)
- …between Cedars-Sinai, UCLA Health 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
- AssistRx (Orlando, FL)
- …us! If hired, receive a $750 referral bonus! A Day in the Life as a Case Manager : This role works directly with healthcare providers & insurance plans/payers to ... the coverage provided for a specific pharmaceutical product. The Case Manager will support the healthcare providers...(PA) for an assigned caseload and helps navigate the appeals process to access medications. + Ensure cases move… more
- Alameda Health System (San Leandro, CA)
- SLH Case Manager RN, Per Diem, Days, 8hoursFeatured Job + San Leandro, CA + San Leandro Hospital + SLH Social Services + Services As Needed / Per Diem - Day + ... + Posted:December 9, 2024 **Summary** **Job Summary:** The SLH Case Manager RN is responsible for providing...contacts with payers conducting phone reviews and initiates denial appeals as needed. 3. Encourages patients to develop realistic… more
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