- 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 all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and...work. On the job or formal training in certified case management, denial and appeals management from… more
- State of Colorado (Denver, CO)
- Administrative Assistant II (Criminal Appeals ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5023135) Apply Administrative Assistant II ... (Criminal Appeals ) Salary $40,036.50 - $50,983.50 Annually Location Denver, CO...complex matters of criminal law and procedure. Key Responsibilities: Case and File Management * Organize, archive, and purge… more
- Molina Healthcare (St. Petersburg, FL)
- …leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider ... complaints, appeals , and claim disputes, and communicating resolution to members,...Coordinates with Customer/Member services, Provider Services, Sales, Enrollment, UM, Case Management, Claims, and other departments within Molina Medicare… more
- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the general direction of the Manager , Appeals and Grievances the Supervisor, Appeals ... and provide leadership for the daily operations of the Appeals and Grievances department. The supervisor represents the ...for many cross department and divisional interfaces (ie, advising case managers in the field, responding to requests from… more
- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the direction of the A&G Manager , the Appeals & Grievances QA Auditor audits the quality ... etc.) as needed. **Job Description** + Review all grievances and appeals prior to case closure including adherence to policies and procedures and regulatory… more
- New York State Civil Service (Liverpool, NY)
- …imposed by the Workers' Compensation Law* Assist in the assignment of cases when the Appeals Unit Manager is absent for extended periods* Assist the Legal ... Attorney 1/ Assistant Attorney 2/ Assistant Attorney 3 / Senior Attorney - Appeals (NY HELPS) Occupational Category Legal Salary Grade NS Bargaining Unit PS&T -… more
- Molina Healthcare (Midvale, UT)
- …unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified ... office with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for … more
- Mount Sinai Health System (New York, NY)
- **Job Description** **RN/ Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **RN/ Case Manager Inpatient Mount Sinai West FT Days 8a-4p EOW (Holiday Rotation)** The Case Manager (CM) will be responsible for all ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information to the payor, as… more
- Sharp HealthCare (San Diego, CA)
- …**Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager ... Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) - American Case...Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers.Review all cases with readmission… more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- …perspective and experience makes ConnectiveRx better than the sum of its parts. The Case Manager 's primary duty is to assist customers with chronic illnesses in ... by gaining access to their wellbeing needs, journey and treatment plan. The Case Manager collaborates and maintains consistent communications with internal and… more
- LifePoint Health (Rutherfordton, NC)
- …admitted to the hospital by facilitating initiation of care starting.2. The ED Case Manager starts initiation and utilization process, encouragement of use of ... discharge plans.5. Follows up with any denials through the appeals process; including RAC chart audit reviews. Emergency Department...appropriate areas of the hospital, ie outpatient.3. The ED Case Manager is responsible for monitoring and… more
- Genesis Healthcare (York, PA)
- …while making a meaningful impact in the communities we serve. Responsibilities The Manager , Case Management is responsible for the clinical, administrative, and ... Manager will also perform the functions of the Case Management Job Description and will be measured based...and outstanding clinical accounts as needed and generates clinical appeals when necessary. 15. Assists with and completes special… more
- TEKsystems (Morrisville, NC)
- Job Title: Work from home Reimbursement Case Manager Job Description As a Reimbursement Case Manager , you will be an expert in reimbursement, co-pay, ... and triage cases according to program standard operating procedures. + Document case management activities in the system, including status and background notes. +… more
- Alameda Health System (San Leandro, CA)
- SLH Case Manager RN, Full Time, Benefited, Days, 8hours, 1.0fteFeatured Job + San Leandro, CA + San Leandro Hospital + SLH Social Services + Full Time - Day + ... + Posted:July 22, 2025 **Summary** **Job Summary:** The SLH Case Manager RN is responsible for providing...contacts with payers conducting phone reviews and initiates denial appeals as needed. 3. Encourages patients to develop realistic… more
- Select Medical (Dallas, TX)
- …White Institute for Rehabilitation** **Dallas, TX** **Neuro Transitional Rehabilitation Center** ** Case Manager (RN, LMSW, PT, OT, SLP)** **Hours: Monday-Friday ... Salary: $70,000** We are currently seeking a Full Time Case Manager with neuro rehabilitation experience, who...the time of discharge. + Obtains insurance authorizations and appeals denials as needed + Works collaboratively with workers… more
- LifePoint Health (Hickory, NC)
- *Registered Nurse (RN), Clinical Case Manager * PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment to ... **Job:** **Nursing* **Organization:** ** **Title:** *Registered Nurse (RN), Clinical Case Manager PRN* **Location:** *NC-Hickory* **Requisition ID:**… more
- Trinity Health (Berwyn, IL)
- **Employment Type:** Full time **Shift:** **Description:** The Lead Case Manager position reports to the Manager of Nurse Care Management. Their specific ... standards of patient care and quality outcomes. + The Case Manager Lead works with the multidisciplinary...of financial indicators including care readmission rates, denial and appeals . + Use data to drive decisions and plan/implement… more
- Highmark Health (Monroeville, PA)
- …BSN **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association - ... + Case Management - American Board of Occupational Health Nurses (ABOHN) andCertified Case Manager (CCM) + Commission for Case Manager Certification… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care ... years nursing experience required, pediatric experience preferred. + Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred.… more