- Genmab (Berkeley Heights, NJ)
- …provide a positive experience. This position reports to the Patient Services Manager , Call Center Operations.The creation of our new internal Genmab Patient Services ... Office Practice Management or Pharmacy. The ideal candidate has experience in case management, phone-based support work and the health insurance landscape. Patient… more
- PharmaCord (Jeffersonville, IN)
- …Acquisition team immediately at ###@pharmacord.com When you join the team as the Case Manager / Patient Advocate (non-clinical), you'll have the opportunity to ... program requirements, and ensuring their prescriptions or cases are handled timely. The Case Manager / Patient Advocate (non-clinical) role may be eligible for… more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The Manager , Denials Prevention & Appeals Operations is responsible for the direct oversight of daily operations of clinical denial ... position will work closely with the Denials Prevention & Appeals Administration Manager to guide the development...with at least 2 years relevant experience in denials, case or utilization management required. * 5 years management… more
- CareFirst (Baltimore, MD)
- …State Licensure And/or Compact State Licensure Upon Hire Required. + CCM - Certified Case Manager Upon Hire Preferred. + LNCC - Legal Nurse Consultant Certified ... educational and training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in the development and… more
- CareFirst (Baltimore, MD)
- …- State Licensure And/or Compact State Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred + LNCC - Legal Nurse Consultant Certified ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Care Manager PreService & Retrospective - Appeals Location: Remote Career Area: ... ensure appropriate resource utilization, identification of referrals to a Health Coach/ case management, and identification and resolution of quality issues. Monitors… more
- New York State Civil Service (Buffalo, 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
- Catholic Health (Buffalo, NY)
- …Specialist, Certified Coder (CPC/CCS), Certified Processional Medical Auditor (CPMA), Certified Case Manager (CCM) or any other certification approved by ... role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the people, carrying out and documenting… more
- Elevance Health (Atlanta, GA)
- **Behavioral Health Medical** **Director-Psychiatrist** ** Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of ... clinical operational aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss… more
- Elevance Health (Las Vegas, NV)
- **Audit & Reimbursement Senior- Appeals ** **_Location:_** _This role enables associates to work virtually full-time, with the exception of required in-person training ... independently on assignments and under minimal guidance from the manager . + Prepare detailed work papers and present findings...report reopenings. + Manage caseload of Medicare cost report Appeals + Position papers + Jurisdictional Reviews + PRRB… more
- Elevance Health (Charleston, WV)
- **Audit & Reimbursement II- Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... Perform cost report reopenings. + Under guided supervision, participate in completing appeals related work: + Position papers + Jurisdictional Reviews + Maintaining… 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 ... term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager or...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as… more
- MVP Health Care (Rochester, NY)
- …innovative thinking and continuous improvement. To achieve this, we're looking for a ** Case Manager , Medicaid Long Term Support Program** to join #TeamMVP. If ... medically complex Medicaid members. + Through collaborative efforts the Case Manager will identify the medical and...maintain cost-effectiveness and manage Medical Loss Ratio (MLR). + Appeals & Denials: Participate in the appeals … 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
- Highmark Health (Pittsburgh, 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
- TEKsystems (Morrisville, NC)
- Reimbursement Case Manager + Will serve as an expert on reimbursement issues and be responsible for handling the day-to-day activities within reimbursement ... services (benefits investigation, prior authorizations and appeals support) + Complete medical and/or pharmacy benefit investigations, identify and facilitate… more
- Alameda Health System (San Leandro, CA)
- SLH Case Manager RN + San Leandro, CA + San Leandro Hospital + SLH Social Services + Part Time - Day + Care Management + $58.74 - $97.91 per hour + Req ... + Posted:October 28, 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. + Encourages patients to develop realistic… more
- HCA Healthcare (Plano, TX)
- …individual is recognized. Submit your application for the opportunity below:Registered Nurse Case Manager IP RehabMedical City Plano **Benefits** Medical City ... vary by location._** We are seeking a(an) Registered Nurse Case Manager IP Rehab for our team...achieving department goals . Track and trend denial and appeals to identify issues and develop action plans for… more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- …/Yr. Submit a Referral (https://careers-connectiverx.icims.com/jobs/3287/sr.- case - manager /job?mode=apply&apply=yes&in\_iframe=1&hashed=-1834382591) Share on ... to achieve resolution of concerns. Manage database for cases. Responsible for timely case resolution and maintaining compliance. Exhibit a high level of case … more
