- Catholic Health Services (Melville, NY)
- …named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... and/or escalates denial when appropriate. Submits all (initial and/or appeals ) reviews and/or letters within contractual or regulatory timeframes. Collaborates… more
- Catholic Health Services (Melville, NY)
- …services and coordinates utilization/ appeals management review. | Assist Utilization and Appeals Manager in setting up communications with payors and/ or ... facility departments. | Develops/validates daily work lists for Utilization and Appeals Manager . | Assist with all insurance and regulatory audits and provides… more
- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals (RN)to lead the daily operations of our ... to, Provider Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances. + Ensures… more
- Evolent (Columbus, OH)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Penn Medicine (Philadelphia, PA)
- …Experience:** + Bachelors degree in Nursing and 5+ years Working as a RN Case Manager and /or Appeals Coordinator required. We believe that the best care for ... you living your life's work? **Summary:** + The Clinical Appeals Coordinator will play an essential role in maximizing...in this important departmental process. They will oversee the appeals and denial process from beginning to end.The Coordinator… more
- CareFirst (Baltimore, MD)
- …educational and training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in the development and ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation...Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred + LNCC - Legal Nurse… more
- Mount Sinai Health System (New York, NY)
- …issues in an accurate and timely fashion. In collaboration with the Underpayment Team manager , the Senior CBO Appeals Analyst will work to further the CBO's ... **Job Description** The Senior CBO Appeals Analyst position requires an in-depth knowledge of...hospital/healthcare environment is required. Advanced knowledge of Epic, Contract Manager , and Microsoft Excel Working knowledge of other Microsoft… more
- Fallon Health (Worcester, MA)
- …information, visit fallonhealth.org. **Brief Summary of Purpose:** Fallon Health's (FH) Appeals and Grievance process is an essential function to FH's compliance ... other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH … more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH … more
- Elevance Health (Tampa, FL)
- **Grievance/ Appeals Analyst Lead** **Candidates must be located within 50 miles an Elevance Health PulsePoint office. This position is primarily work from home but ... to work in the office quarterly.** **Schedule: Monday-Friday 8am-5pm EST** The **Grievance/ Appeals Analyst Lead** is responsible for leading and coaching a team of… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... business need) Unrestricted RN licensure **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals… more
- The County of Los Angeles (Los Angeles, CA)
- …quality assessment and assurance monitoring processes; and handle informal complainant appeals . Health Facilities Program Manager , Nursing positions are required ... HEALTH FACILITIES PROGRAM MANAGER , NURSING Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4626091) Apply HEALTH FACILITIES PROGRAM MANAGER… more
- Intermountain Health (Columbus, OH)
- **Job Description:** The Manager , RN Revenue Integrity Audit, Recovery and Appeals organizes and manages the daily operations of the Audit and Recovery teams in ... (RSC) reporting directly to the Sr. Director, Revenue Integrity. The region-wide manager is responsible for the team's performance coordination and responses to… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- Centralized Appeals Unit - Supervisor Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4881433) Centralized Appeals Unit - Supervisor ... + Description + Benefits Supplemental Information Please click HERE (https://ulsuno.wd1.myworkdayjobs.com/en-US/UniversityOfNewOrleans/job/Baton-Rouge-La/Centralized- Appeals -Unit Supervisor\_R-001713?q=R-001713) to apply + Manage and report on… more
- Elevance Health (Chicago, IL)
- …components of clinical referrals. **How you will make an impact:** + Reviews appeals for completeness and follows up for additional information if necessary. + ... Assigns escalated appeals to staff as appropriate. + Responds to inbound...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Mount Sinai Health System (New York, NY)
- **Job Description** This position serves as Appeals Analyst for Central Billing Office management. Responsible for monitoring contractual allowances, analyzing and ... pursuing appeals opportunities with payors and networks, and reporting performance...and analyzes data in our contract compliance tool (Contract Manager ), EPIC, and payor policy detail for identified payment… more
- State of Massachusetts (Boston, MA)
- …and Bonds ("the board"), which is responsible for conducting administrative hearings for appeals of actions, rulings or decisions of the Registrar of Motor Vehicles ... a record of all proceedings before the board and shall collect data on appeals , board outcomes and key performance metrics as determined by the Commissioner of… more
- Catholic Health (Buffalo, NY)
- …potential Summary: This position is accountable for carrying out and documenting the appeals process for denied claims denied due to reasons including, but not ... front-end clinical areas and third party payers in scenarios related to denials and appeals . This position educates all members of the patient care team on an… more
- Beth Israel Lahey Health (Burlington, MA)
- …availability, and discusses issues with outside auditors and the inpatient coding manager /CDI. Prepares appeals on appropriate cases to ensure proper ... or adjusting grievances involving colleagues; interview and select, with the manager , candidates for employment.** **Proactively develop plans to meet future… more
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