- VNS Health (Manhattan, NY)
- VNS Health is seeking a Social Work Licensed Clinical Social Worker for a job in Manhattan, New York.Job Description & RequirementsSpecialty: Licensed Clinical ... and recovery goals at the forefront of all initiatives. This position is hybrid . What We ProvideReferral bonus opportunities Generous paid time off (PTO), starting… more
- CareFirst (Baltimore, MD)
- …programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Appeals and Analysis **Equal Employment Opportunity** ... all lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State...who is willing and able to work in a hybrid model. The incumbent will be expected to work… more
- Elevance Health (Los Angeles, CA)
- ** Manager I - Grievances & Appeals - Member... Appeals ** **Location** : This position will work a hybrid model (in office 1-2 days per week). The ideal ... of our Elevance Health PulsePoint locations in California. The ** Manager I - Grievances & Appeals ** is...clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and… more
- Elevance Health (Mason, OH)
- …contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and clinical services, ... **Location: Open to any location but must meet the hybrid workplace model requirement.** Elevance Health supports a hybrid workplace model (virtual and office)… more
- Elevance Health (Indianapolis, IN)
- Job Description **Title: Grievance/ Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live ... 50 miles of one of our PulsePoint locations. The **Grievance/ Appeals Analyst I** is an entry level position in...HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of… more
- Elevance Health (Los Angeles, CA)
- **Title: Grievance/ Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The **Grievance/ Appeals Analyst I** is an entry level position in...HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of… more
- Elevance Health (Rancho Cordova, CA)
- **Nurse Appeals - Licensed RN Nurse** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the state of ... Monday to Friday from 8:00-5:00 pm PT The **Nurse Appeals ** is responsible for investigating and processing medical necessity.../grievances/quality of care issues and is a resource for clinical and non clinical team members in… more
- Elevance Health (Los Angeles, CA)
- **Nurse Appeals (Quality) - California candidates only** **Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health ... skills and serves as a subject matter expert for appeals /grievances/quality of care issues and is a resource for.../grievances/quality of care issues and is a resource for clinical and non clinical team members in… more
- CareOregon (Portland, OR)
- …Medical Management Administration Exemption Status Exempt Requisition # 24536 Direct Reports N/A Manager Title Sr Medical Director - Clinical Services Pay & ... regulatory requirements, and in partnership with our network providers, develop a clinical strategy to improve population health, coordinate care, and meet CMS STARS… more
- Elevance Health (Chicago, IL)
- **Sign-on Bonus:** $10,000 The ** Clinical Operations Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent ... locations. **How you will make an impact:** + Ensures timely completion of clinical case reviews for their board certified specialty. + Makes physician to physician… more
- University of Michigan (Ann Arbor, MI)
- …organizational policies, OIG guidelines, and other applicable regulations. Overall, the manager utilizes project management skills, clinical knowledge and ... REVENUE CYCLE CODING MANAGER - CODING QUALITY/EDUCATION Apply Now **Job Summary**...Compliance Specialists (MCCS), The PB Denials Team, and the Appeals and Denial Coordinators. These professionals support coding compliance,… more
- Banner Health (Tucson, AZ)
- …City/State:** Arizona, Arizona **Department Name:** **Work Shift:** Day **Job Category:** Clinical Care The future is full of possibilities. At Banner Plans ... opportunities and innovative employment options by offering remote and hybrid work settings. In the role of a Behavioral...In the role of a Behavioral Health Utilization Care Manager , you will be tasked with assignments at various… more
- Centene Corporation (Tallahassee, FL)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... role. **Position Purpose:** Manage Specialty Therapy and Rehabilitation Services (STRS) clinical services including management and marketing of clinical services… more
- Elevance Health (Kansas City, KS)
- …+ Uses tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for ... member's cases (serving as the single point of contact) with the clinical healthcare management and interdisciplinary team in order to provide care coordination… more
- Centene Corporation (Springfield, IL)
- …to document, investigate and resolve formal or informal complaints and appeals in accordance with Company and State policies, procedures and requirements. ... degree in related field or equivalent experience. 3+ years clinical , quality management or healthcare related experience and 1...holidays, and a flexible approach to work with remote, hybrid , field or office work schedules. Actual pay will… more
- Elevance Health (Atlanta, GA)
- …oversight from immediate manager . + May be responsible for an entire clinical program and/or independently performs clinical reviews. + The Medical Director ... an individual contributor role. This position will work a hybrid model (remote and office). Ideal candidates will live...Child & Adolescent Psychiatrist who will be responsible for appeals reviews within our Medicaid and Medicare programs.** The… more
- University of Michigan (Ann Arbor, MI)
- …coordinate all activities related to the response to external audit activities, appeals , and denials. Work with stakeholders to create proactive systems that will ... activities are performed independently but in consultation with the Senior Manager . **What You'll Do** **LEADERSHIP** Provide leadership for the Birth Certificate… more
- AmeriHealth Caritas (Newark, DE)
- …leadership in the operational areas of care management, utilization review, appeals , quality improvement and related policy and practice initiatives in collaboration ... throughout the provider network. + Overseeing the quality of clinical care for network and non-network providers. + Engaging...associates and Providers. + Serves as medical advisor and manager for all clinically related activities. + Assures that… more
- VNS Health (Manhattan, NY)
- …recovery goals at the forefront of all initiatives. This position is hybrid . Compensation Range:$137,800.00 - $229,700.00 Annual Along with our highly competitive ... base pay, we offer pay differentials based on education, clinical experience, certifications, and work in high need areas....the VNS Health Social Services Community of Professionals + Hybrid (about 2 days per week in the office)… more
- Elevance Health (Miami, FL)
- …oversight from immediate manager . + May be responsible for an entire clinical program and/or independently performs clinical reviews. + The Medical Director ... **This position will work a hybrid model (remote and office). Ideal candidates must...programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor… more
