- Blanchard Valley Health System (Findlay, OH)
- …Care Transitions Team, including the disciplines of Social Work, Case Management, Utilization Review, and Emergency Department Care Navigation to support ... of the interdisciplinary care transition team. The acute care transition manager fosters communication and collaboration across the health system, develop safe,… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …About the Role:Job SummaryManages the day to day operations of the department by supporting the case management and interdisciplinary healthcare team in facilitating ... patient care through the continuum. Monitors department activities to ensure optimum case management, including education, competency and accountability of the… more
- Northeast Georgia Health System, Inc (Oakwood, GA)
- …documentation of the pre-certification into the appropriate account.Collaborates with the appeals department to provide all related information to overturn ... health of our communities. About the Role:Job SummaryUnder the supervision of the Utilization Review Manager , this position is responsible for ensuring the… more
- BronxCare Health System (Bronx, NY)
- …Management Position Type Regular Full-Time Division Bronxcare- Yonkers Max USD $97,125.00/Yr. Shift Day Shift Department : Name Appeals Department (BHCS) ... 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… more
- VNS Health (Manhattan, NY)
- …the day to day management of clinical appeals review processes within Appeals & Grievances Department . + Manages the intake, investigation and resolution of ... of members experience with A&G. + Tracks grievances and appeals that are in process in the department...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… more
- CareFirst (Baltimore, MD)
- …+ Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used ... contribution programs/plans (all benefits/incentives are subject to eligibility requirements). ** Department ** Clinical Appeals and Analysis **Equal Employment… more
- University of Washington (Seattle, WA)
- …PATIENT FINANCIAL SERVICES Department ** has an outstanding opportunity for a **CLINICAL APPEALS AND DISPUTES NURSE** **Work Schedule** + 100% FTE + 100% Remote + ... Req #: 239052 Department : UW MEDICINE - PATIENT FINANCIAL SERVICES Posting...chart auditor, certified professional in utilization review(or utilization management or healthcare management), certified case manager… more
- Elevance Health (Columbus, GA)
- … Analyst I** is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post ... **Title: Grievance/ Appeals Analyst I** **Location:** This position will work...requirements. + As such, the analyst will strictly follow department guidelines and tools to conduct their reviews. +… more
- Elevance Health (Los Angeles, CA)
- … Analyst I** is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post ... **Title: Grievance/ Appeals Analyst I** **Location:** This position will work...requirements. + As such, the analyst will strictly follow department guidelines and tools to conduct their reviews. +… more
- Elevance Health (Richmond, VA)
- …post service grievances and appeals requests in the Enterprise Grievance & Appeals Department from customer types (ie member, provider, regulatory, and third ... **Title: Grievance/ Appeals Analyst II** **Location:** This position will work...requirements. + As such, the analyst will strictly follow department guidelines and tools to conduct their reviews, and… more
- Molina Healthcare (Georgetown, KY)
- …Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training, leadership and mentoring for less ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...has been made or upon request by another Molina department to reduce the likelihood of a formal appeal… more
- The 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 ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Hackensack Meridian Health (Hackensack, NJ)
- …determinations - OBS vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based Appeals Management e. ... documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate...e. Provides professional support to the functions within the Utilization Management Department f. Provides periodic written… more
- The Mount Sinai Health System (New York, NY)
- …to insure patient admission is approved Identifies and refers to the UM Manager &/or Administrator and/or Physician problematic utilization and quality issues ... Responsible for the maintenance of accurate data for approvals, denials and appeals (in coordination with UM Manager and management). Prioritizes insurance… more
- Billings Clinic (Billings, MT)
- …80 hours (Non-Exempt) Starting Wage DOE: $35.34 - 44.18 Under the direction of department leadership, the Utilization Review/ Management RN. This position is to ... cases that require second level review to Physician Advisor, Manager , and Director per department process or...to department leadership and Physician Advisor, per department process or procedure Insurance and Utilization … more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department : Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... in the department 's continuous quality improvement activities. Communicates to UM Manager and supervising RN, barriers to completing assignments or daily work in… more
- Hackensack Meridian Health (Holmdel, NJ)
- …information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains ... and serve as a leader of positive change. The **Care Management, Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for… more
- Hackensack Meridian Health (Hackensack, NJ)
- …information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains ... and serve as a leader of positive change. The Case Management Care Coordinator, Utilization Management is a member of the healthcare team and is responsible for… more
- Alameda Health System (Oakland, CA)
- Manager , Care Management + Oakland, CA + Highland General Hospital + HGH Care Coordination + Full Time - Day + Management + Req #:38499-28188 + FTE:1 + ... paid time off plans **Role Overview:** Alameda Health System is hiring! The Manager of Care Management is responsible for the day-to-day operations of facility wide… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- Manager of Donor Engagement and Annual Giving Programs Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4630891) Apply Manager of Donor ... Location Baton Rouge, LA Job Type Unclassified Job Number BRCC082224 Department Baton Rouge Community College Opening Date 08/22/2024 Closing Date Continuous… more
