- Guardian Life (Bethlehem, PA)
- …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 2 provides a full and fair...required. + 5+ years of Group Disability and/or Life claims experience. + 3+ years of experience handling appeals… more
- Elevance Health (St. Louis, MO)
- **Telephonic Nurse Case Manager II ** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point ... of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II ** is responsible...as applicable. + Assists in problem solving with providers, claims or service issues. **Minimum Requirements:** Requires a BA/BS… more
- State of Massachusetts (Boston, MA)
- …deliver program integrity. *What you'd do:* Lead Claims Examiner/Job Service Representative II , who reports to the Senior Manager of Benefit Operations & ... *Lead Claims Examiner/Job Service Representative II | Department...Job Service-Representative I's on fact-finding and the resolution of case issues. Interpret and explain relevant laws, regulations, policies… more
- City of New York (New York, NY)
- … who will: - Directly and indirectly supervise staff (PAAII, PAAI, Eligibility Specialist II ) involved in Claims processing. - Monitor and distribute cases in ... Office of Revenue that houses SNAP-CR. They establish SNAP claims for the agency according to the Federal SNAP...of actions for potential SNAP benefit overpayments on agency case actions from all CA and SNAP sites from… more
- Santa Clara Valley Water District (CA)
- …be administered by this Senior Management Analyst, with support from a Management Analyst II , and oversight by the Grants Unit Manager . Senior Management Analyst ... Grants Senior Management Analyst/ Analyst II Print (https://www.governmentjobs.com/careers/scvwd/jobs/newprint/4727922) Apply Grants Senior Management Analyst/… more
- State of Massachusetts (Boston, MA)
- The incumbent of this position will review, analyze and evaluate disputed claims to ensure uniformity with State and Federal rules and regulations by analyzing ... to staff on fact-finding, the resolution of nonmonetary issues and the claims filing process. Interpret and explain relevant laws, regulations, policies and… more
- CareFirst (Baltimore, MD)
- …and procedures. **ESSENTIAL FUNCTIONS:** + Audits assigned function (service, claims , enrollment) for accuracy, benefit payment, contract interpretation, and ... or GED. **Licenses/Certifications Preferred:** + ECA Certified Quality Assurance Manager **Experience:** + 5 years Auditing, Quality Assurance, Operations, Training,… more
- Sutter Health (Castro Valley, CA)
- …patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely ... management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and… more
- LA Care Health Plan (Los Angeles, CA)
- …Worker; current and unrestricted California License. Licenses/Certifications Preferred Certified Case Manager (CCM) Required Training Physical Requirements Light ... Care Management Specialist II - MCLA Team Job Category: Clinical Department:...skills and judgement. Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and… more
- JBS USA (Columbia, MO)
- **Description** Human Resources Manager Purpose and Scope/General Summary: We are looking for a Human Resources Manager for JBS Prepared Foods that reports ... onsite to the Columbia, MO plant. The Human Resources Manager will lead all Human Resources efforts at the plant level including hiring and recruiting, training and… more
- WellSpan Health (York, PA)
- Patient Financial Services Representative II - Govt Billing - Days Location: WellSpan Health, York, PA Schedule: Full Time General Summary Completes assigned revenue ... Cycle functions including, submitting electronic and / or manual insurance claims , resolves claim edits, performs insurance account follow-up, researches claim… more
- Army National Guard Units (Niantic, CT)
- …permanent without further competition. This National Guard position is for a NURSING ( CASE MANAGER )(Title 5), Position Description Number T5637P01 and is part of ... this position. Additional Information CONTINUATION OF SPECIALIZED EXPERIENCE: Experience performing Case Manager Consultant work and coordinating record results… more
- US Tech Solutions (Columbia, SC)
- …determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, ... Management Certification must be obtained within 4 years of hire as a Case Manager . Preferred Education: Bachelor's degree- Nursing Preferred Work Experience: 7… more
- LA Care Health Plan (Los Angeles, CA)
- Authorization Technician II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: ... net required to achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …As a member of Premera's Special Investigations Unit (SIU), the **Investigator II ** is responsible for developing, collecting, and evaluating information and data, ... to perform analysis and obtain analytical information of significance to support case investigations. You will also conduct proactive fraud detection using available… more
- LA Care Health Plan (Los Angeles, CA)
- …Active, current and unrestricted California License Licenses/Certifications Preferred Certified Case Manager (CCM) Required Training Physical Requirements Light ... to develop and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service… more
- Arizona Public Service (Phoenix, AZ)
- HR Service Center Associate II | HR Services & Operations Apply now " Date: Jan 8, 2025 Location: PHOENIX, AZ, US, 85004-3903 Company: APS Our present and future ... Other and Succeed Together. Summary HR Service Center Associate II | HR Services & Operations Are you passionate...with the goal of resolving at first contact. Owns case management process which includes opening, managing escalation and… more
- ManpowerGroup (Columbia, SC)
- …recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager If this is a role that interests you and you'd like to ... established criteria to manage medical or behavioral health eligibility, provide case management, and ensure compliance with regulations and benefits guidelines.… more
- Elevance Health (Miami, FL)
- …Miami or Tampa Florida. **Schedule:** 12 noon- 8:30 pm EST The **Transplant Nurse II ** is responsible for providing case and/or medical management for members ... preparation for advancement to the senior level. Within the case management role will within the scope of licensure...treatment plans. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Duke Energy (Plainfield, IN)
- …and review of governmental filings, including quarterly and annual FERC reports, rate case support, insurance claims and recoverables as needed. + Work with ... and benefits. Depending upon the desired qualifications of the successful applicant, the hiring manager may elect to fill this position at a higher level within the… more
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