• Novo Nordisk Inc. (Plainsboro, NJ)
    …area(s) to increase efficiency, medical alignment, and mitigate risk of promotional claims Review , provide comments and document verdicts for all assigned ... with a bachelor's degree in healthcare (eg post-doctoral fellowship, promotional review , clinical pharmacy, hospital pharmacy, etc.) Thorough understanding of… more
    HireLifeScience (11/07/24)
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  • Medical Claims FP&A Senior Manager

    The Cigna Group (Denver, CO)
    The Medical Claims FP&A Senior Manager will manage projection and results analysis for core Medicare Advantage Part C medical claims expense processed and ... is expected to be the largest focus for the manager in the medium and long term. This individual...Familiarity with R/Python a plus. + Experience with medical claims , clinical , and financial data + An… more
    The Cigna Group (10/22/24)
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  • Sr. Disability Claims Examiner

    Kohler Co. (Kohler, WI)
    …to functional job requirements for work accommodation. + Facilitate medical case review with clinical experts when disability or duration of disability ... + Coordinate investigative efforts as necessary, ensuring appropriateness; provides thorough review of contested claims . + Evaluates and arranges appropriate… more
    Kohler Co. (10/17/24)
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  • RN Clinical Provider Post Service…

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …provider call center, provider correspondence and appeals, clinical review , member correspondence and reconsiderations, enrollment, claims processing, ... is BCBSMA's single largest account Position Summary: The RN Clinical Provider Post Service Review Manager...by the FEP Association to ensure compliance and accurate case/ claims processing This leader must demonstrate the attributes and… more
    Blue Cross Blue Shield of Massachusetts (10/23/24)
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  • Healthcare Claims Denials Specialist

    CenterWell (Topeka, KS)
    …community and help us put health first** As an **Accounts Receivable Specialist/Healthcare Claims Denials Specialist** , you will: + Ensure the coordination of claim ... timely reimbursement of receivables. + Research, resolve, and prepare claims that have not passed the payer edits daily....Prepare input data forms to update computer system. + Review and communicate with agencies to educate them about… more
    CenterWell (10/30/24)
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  • Senior Clinical Risk Manager

    University of Washington (Seattle, WA)
    …potential professional liability exposures and report to the UW Liability Claims Manager . Document reviews, including:o Identification and preservation of ... excitement, artistic pursuits and natural beauty. **POSITION PURPOSE** The Senior Clinical Risk Manager 's (Compliance Analyst (ES 10)) primary responsibility… more
    University of Washington (10/08/24)
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  • Patient Account Representative - Physician…

    Guidehouse (Lewisville, TX)
    …from home._** **_Questions regarding this position, you may contact Chris Rivera ( Manager , Talent Acquisition) at ###._** The Patient Account Representative has an ... receivable follow-up, timely filing guidelines and the ability to effectively review remittance advices and electronic billing reports from payer to determine… more
    Guidehouse (11/03/24)
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  • Clinical Risk Manager - Quality…

    Memorial Sloan-Kettering Cancer Center (New York, NY)
    …more. Please note, this link is only accessible for MSK employees. Job Description Clinical Risk Manager - Quality & Safety Intriguing opportunity available. We ... are seeking a Clinical Risk Manager to join our Quality...its captive insurance program, and excess insurance carriers) on clinical risk and claims issues and will… more
    Memorial Sloan-Kettering Cancer Center (11/07/24)
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  • Claims and Denial Coding Analyst

    St. Luke's University Health Network (Allentown, PA)
    …is a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding related claim denials for professional services, FQHC, ... tools and Insurance carrier medical and reimbursement policies during the claim review process. JOB DUTIES AND RESPONSIBILITIES: + Maintain current knowledge of… more
    St. Luke's University Health Network (10/16/24)
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  • Clinical Data Manager

    American Heart Association (Columbus, OH)
    …does your career. The American Heart Association has an excellent opportunity for a ** Clinical Data Manager ** in our **National Center** office. Location of the ... to be able to integrate data from different sources ( clinical , claims , patient-reported survey data, food vendors)....have a competitive base salary. That's why we regularly review the market value of jobs and make adjustments,… more
    American Heart Association (09/13/24)
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  • Clinical Risk Manager

    Moses/Weitzman Health System (Middletown, CT)
    **Job Description Summary:** **Job Description:** **NATURE OF POSITION:** The Clinical Risk Manager leads and oversees risk management efforts at CHC and works ... collaboratively with the MWHS Legal Department, senior clinical leaders, practice administration, facilities and support staff at CHC to carry out the General Duties… more
    Moses/Weitzman Health System (10/09/24)
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  • Clinical Pharmacy Manager - World…

    Mount Sinai Health System (New York, NY)
    …in the NY/NJ region. MSHS, World Trade Center Health Program (WTCHP) seeks a Clinical Pharmacy Manager that reports to Senior Manager , Pharmacy Benefits ... under the direction of the WTCH medical leadership. The Clinical Pharmacy Manager will have direct patient...practitioners as required + Performing prescription audits such as review to improve generic medication use, prescribing patterns and… more
    Mount Sinai Health System (11/07/24)
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  • Program Manager - Clinical

    Shaw Industries Inc (Dalton, GA)
    …Partner with the Benefits Manager and Lead Leave Administrator to provide a clinical review of Health & Wellness and Leave Mgmt. teams call centers ... Job Title Program Manager - Clinical Partnerships Position Overview...and claimant data. This role will also engage in clinical review of topics for associate outreach… more
    Shaw Industries Inc (10/30/24)
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  • Manager , Clinical Risk Management

    Hackensack Meridian Health (Perth Amboy, NJ)
    …transform healthcare and serve as a leader of positive change. The ** Manager , Risk Management** provides basic and complex preventive risk management assessment of ... Bridge Medical Center. **Responsibilities** A day in the life of a ** Manager , Risk Management** at **Hackensack Meridian** **_Health_** includes: + Provide prompt… more
    Hackensack Meridian Health (09/12/24)
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  • Clinical Account Manager

    Access Dubuque (Dubuque, IA)
    …services, aiming to exceed client expectations and support retention. + Manage the clinical review and prior authorization processes, explaining clinical ... Clinical Account Manager **MedOne Pharmacy Benefit...clinical improvement recommendations, and implement cost-containment strategies. + Review and approve specialty drug requests and appeal reviews… more
    Access Dubuque (10/18/24)
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  • Clinical Risk Manager - Hospital…

    Mount Sinai Health System (New York, NY)
    **Job Description** The Clinical Risk Manager reports to the Director of Risk Management and Patient Safety and is responsible for reviewing, summarizing, ... to day risk management activities the Mount Sinai Health System (MSHS)., The Clinical Risk Manager conducts investigations and prepares reports as required by… more
    Mount Sinai Health System (10/06/24)
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  • Clinical Risk Manager

    AdventHealth (Palm Coast, FL)
    …potential or have caused a serious injury or death. . Maintains and coordinates claims control. . Reviews, or provides for review , of records and documentation ... even better. **Shift** : FT Days **The role you'll contribute:** The Risk Manager plans, develops, and administers the system's Risk Management Program for loss… more
    AdventHealth (08/13/24)
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  • Clinical Manager - Home Health

    CareerStaff Unlimited (Danvers, MA)
    Clinical Manager -Home Health We are...that the staff provides. 3. Meets with clinicians to review patient caseloads, and assess the quality of care, ... currently seeking a Home Health Clinical Manager , in the Danvers, MA area....Compliance and Ethics Program, Standard/Code of Conduct, Federal False Claims Act and HIPAA. 17. Identifies and resolves issues… more
    CareerStaff Unlimited (10/18/24)
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  • Senior Clinical Risk Manager

    Mount Sinai Health System (New York, NY)
    …Ground breaking science. Advancing medicine. Healing made personal. **Job Title: Senior Clinical Risk Manager - Mount Sinai West** **Job Summary:** The ... Senior Clinical Risk Manager serves as a resource...Cause Analysis investigations which include assessing need for focused review by departments, and/or clinical chairpersons for… more
    Mount Sinai Health System (10/17/24)
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  • Senior Clinical Risk Manager

    Mount Sinai Health System (New York, NY)
    **Job Description** Senior Clinical Risk Manager The Senior Clinical Risk Manager serves as a resource to staff to enhance patient safety, promote ... protect the assets of the facility. The Senior Risk Manager supports the Risk Management staff on how best...Cause Analysis investigations which include assessing need for focused review by departments, and/or clinical chairpersons for… more
    Mount Sinai Health System (09/28/24)
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