- Warren Equipment Company (Oklahoma City, OK)
- **Description** TEAM UP WITH US! The Senior Facilities Manager oversees and manages all aspects of facility operations across multiple dealership sites, ensuring ... the facility infrastructure capital plan. . Inspect facilities and evaluate space utilization across multiple sites to ensure efficient use and alignment with… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and ... to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials… more
- Elevance Health (Cerritos, CA)
- **Title: Grievance/ Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... for employment, unless an accommodation is granted as required by law._ The **Grievance/ Appeals Analyst I** is an entry level position in the Enterprise Grievance &… more
- Elevance Health (Mason, OH)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... **Medical Director-Dermatology Appeals ** **Location:** This role enables associates to work...and quality. + Work independently with oversight from immediate manager . + May be responsible for an entire clinical… more
- Elevance Health (Indianapolis, IN)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... ** Appeals Medical Director - Indiana Medicaid** **Location:** This...and Family Medicine specialties preferred. + 3-5 years of Utilization Management experience preferred. + Indiana license or the… more
- Elevance Health (Los Angeles, CA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... **Behavioral Health Medical** **Director-Psychiatrist** ** Appeals ** **Location:** This role enables associates to work...Director Associates. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical… more
- Huron Consulting Group (Chicago, IL)
- …our team as the expert you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, and ... are met. + Performance Tracking and Improvement: Provides analysis and reports of utilization , denials, and appeals KPIs, trends, patterns, and impacts to… more
- Children's Mercy Kansas City (Kansas City, MO)
- …and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing ... functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital performance improvement… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts...concurrent and extended stay reviews. + Prepares and submits appeals to third party payors. + Maintains appropriate records… more
- Corewell Health (Grand Rapids, MI)
- …all components of insurance prior authorizations, initial reviews, continuous stay reviews and appeals . Nurse Care Manager - Plans and prioritizes care for ... waiting list, insurance prior authorizations, continuous stay reviews and appeals . Additional support to the UM functions of the...Cross Ambulatory Care Management Upon Hire required + Case Manager , Certified (CCM) - CCMC Commission for Case … more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... ensure compliance with utilization management policies. This role conducts admission and continued...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- Community Health Systems (Franklin, TN)
- … Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals activities. This ... timely authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities, assists… more
- University of Utah Health (Salt Lake City, UT)
- …advancement, and overall patient outcomes. **Responsibilities** + Applies approved utilization criteria to monitor appropriateness of admissions with associated ... or third-party payer. + Alerts and discusses with physician/provider and case manager /discharge planner when patient no longer meets medical necessity criteria for… more
- Saint Francis Health System (Tulsa, OK)
- …in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal ... the Process Improvement/Quality Director, to appropriate clinicians and to the UM Manager . Reviews eligibility and benefits of patients, matching the level of care… more
- Healthfirst (NY)
- …but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions** + **Partner ... maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** +… more
- NTT America, Inc. (Plano, TX)
- …and forward-thinking organization, apply now. We are currently seeking a Delivery Senior Manager to join our team. NTT DATA is seeking to hire a **Medicare ... Appeals Clinical Leader** to lead service delivery engagements and...corrective actions + Collaborate with health plans, clinical teams, utilization management, and other departments to address complex cases… more
- Calvary Hospital (Bronx, NY)
- The RN Case Manager (RNCM) will be responsible for all aspects of case management for an assigned group of patients to determine the appropriateness of the Level of ... the expected length of stay (ELOS). The RNCM participates in the Utilization Review, Discharge Planning, Risk Management, and Quality Assessment and Performance… more
- Mount Sinai Health System (New York, NY)
- …Experience Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. ... **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Guthrie (Sayre, PA)
- Summary The Denial, Appeal, and Audit Manager is responsible for the oversight and management of all payer denials, appeals , and audit processes within the ... of claim denials, effective appeal strategies, and proactive audit response. The manager leads a team of specialists, coordinates with internal departments, and… more
- Sharp HealthCare (San Diego, CA)
- …**Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered ... Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) - American Case Management Association (ACMA); Bachelor's Degree in Nursing; Master's… more
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