- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews ... from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… more
- Catholic Health Services (Melville, NY)
- …for services and coordinates utilization / appeals management review. | Assist Utilization and Appeals Manager in setting up communications with payors ... Managers, physician advisors and facility departments. | Develops/validates daily work lists for Utilization and Appeals Manager . | Assist with all insurance… 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 ... management of clinical appeals review processes within Appeals & Grievances Department . + Manages the...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… more
- Evolent (Columbus, OH)
- … Utilization Management is required. + Minimum of 5 years in Utilization Management, health care Appeals , compliance and/or grievances/complaints in a quality ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a... and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies… 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 ... + Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used… more
- Molina Healthcare (Columbus, OH)
- …Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training, leadership and mentoring for less ... Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical peers. +… more
- Molina Healthcare (Columbus, OH)
- …Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training, leadership and mentoring for less ... and Wed - Saturday._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical...has been made or upon request by another Molina department to reduce the likelihood of a formal appeal… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... concurrent and extended stay reviews. + Prepares and submits appeals to third party payors. + Maintains appropriate records...third party payors. + Maintains appropriate records of the Utilization Review Department . + Performs related duties,… more
- Molina Healthcare (Columbus, OH)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Ochsner Health (Lafayette, LA)
- …the daily operations of all assigned divisions within the case management department in collaboration with the case management and social services leadership. ... systems (CMS) regulations, compliance and quality metrics. Experience managing denials and appeals of all payer cases in a timely and organized manner. Preferred… more
- AmeriHealth Caritas (Newtown Square, PA)
- …provides organizational leadership in the operational areas of care management, utilization review, appeals , quality improvement and related policy and ... practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The following… more
- Whidbey General Hospital (Coupeville, WA)
- …home health, Hospice, skilled nursing, anti-biotic regime, etc. The RN - Care Manager follows the hospital's Case Management/ Utilization Plan that integrates the ... JOB SUMMARY The RN - Care Manager is a health care professional with experience...indicators including LOS, cost per case, avoidable days, resource utilization , readmission rates, concurrent denials, and appeals .… more
- Mount Sinai Health System (New York, NY)
- …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years? experience as a ... **Job Description** The Case Manager is responsible for all aspects of case management/ utilization review for an assigned group of inpatients, ED patients and… more
- Sharp HealthCare (La Mesa, CA)
- …documents as appropriate in the electronic medical record and provides information to the department head as indicated. + Utilization review and utilization ... **Facility:** Grossmont Hospital **City** La Mesa ** Department ** **Job Status** Regular **Shift** Day **FTE** 1...(RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) - American Case Management Association (ACMA); Bachelor's… more
- Mount Sinai Health System (New York, NY)
- …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years? experience as a ... **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Houston Methodist (Houston, TX)
- …incidental overtime and overtime percentage, and other areas according to department specifications. + Manages utilization management (UM) programs including ... At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible...functional and operational aspects of the Case Mgmt./Social Work department , an integrated, interprofessional department which supports… more
- Mount Sinai Health System (New York, NY)
- …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years? experience as a ... **Job Description** The Case Manager (CM) will be responsible for all aspects...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Methodist Health System (Dallas, TX)
- …Of Week :** Mon-Fri **Work Shift :** **Job Description :** Your Job: The Manager of Collections Physician Billing is responsible for overseeing the AR follow up team ... drive performance improvements and meet departmental and organizational goals. The Manager will work closely with various internal and external departments,… more
- State of Colorado (Rifle, CO)
- …This position is involved in quality assurance of the medical records department ; coordinates the Utilization Review Committee and maintains the minutes, ... Health Information Manager - Med Records Tech II - Rifle...from your receipt of notice or acknowledgement of the department 's action. For more information about the appeals… more
- Stanford Health Care (Palo Alto, CA)
- …waiting to be discovered. Day - 12 Hour (United States of America) Department : Social Work Outpatient Commitment: Part-time (0.6 FTE) Schedule: This role will ... Background in Behavioral Health with Pediatric Patients - Experience in an Emergency Department Why work at Stanford Medicine | Stanford Health Care (SHC)? *… more
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