- 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
- 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
- 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
- MD Anderson Cancer Center (Houston, TX)
- …The primary purpose of the PBS Associate position is to follow-up on billed claims within regulatory guidelines. The PBS Associate must ensure that all claims ... calls in order to ensure prompt payment of medical claims . 2. Responds to requests made by third party...service. 4. Identifies denial trends and notifies Supervisor and/or Manager to prevent future denials and further delay in… more
- 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
- 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
- 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
- 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
- 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
- Trinity Health (Boise, ID)
- **Employment Type:** Full time **Shift:** **Description:** **GENERAL SUMMARY AND PURPOSE:** The Clinical Risk Manager is to ultimately provide a safer hospital ... remedial actions. Reassign events to appropriate department/clinic leadership and/or to peer review . Ascertain clinical course of patient from documentation and… more
- 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
- 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
- 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
- Colorado State University (Fort Collins, CO)
- Posting Detail Information Working TitleHuman Resources Manager , Department of Clinical Sciences Position LocationFort Collins, CO Work LocationPosition ... at Colorado State University seeks applications for a 12-month full-time Human Resources Manager . The Department of Clinical Sciences mission is to assure the… more
- 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
- 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
- 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
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and coordinate… more
- 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 (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
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