- 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 #:42605-31625 ... + FTE:0.7 + Posted:August 6, 2025 **Summary** **JOB SUMMARY** The SLH Case Manager RN is responsible for providing comprehensive case management services to clients… more
- Warren Equipment Company (Tulsa, OK)
- **Description** TEAM UP WITH US! The Senior Facilities Manager oversees and manages all aspects of facility operations across multiple dealership sites, ensuring ... the facility infrastructure capital plan. . Inspect facilities and evaluate space utilization across multiple sites to ensure efficient use and alignment with… 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
- 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...the Physician Advisors or attending physicians to support concurrent appeals . * Monitor and analyze utilization data… more
- CareFirst (Baltimore, MD)
- …mandates. Directs the activities and serves as a resource for associates within the Appeals and Grievances Department for Government Programs. We are looking for ... 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)
- …+ Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used ... contribution programs/plans (all benefits/incentives are subject to eligibility requirements). ** Department ** Clinical Appeals and Analysis **Equal Employment… more
- Beth Israel Lahey Health (Charlestown, MA)
- …difference in people's lives.** This is a remote based role. Reporting to the Manager , Patient Financial Services, the Clinical Analyst plays an important role in a ... high-profile team tasked with handling all commercial and government clinical appeals and audit processes. The Clinical Analyst will perform high-level clinical… more
- Children's Mercy Kansas City (Kansas City, MO)
- …review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital performance ... to integrated inpatient teams; assists Director in the management of department ; including personnel and fiscal management and development of, and training… more
- Mount Sinai Health System (New York, NY)
- …Nurse denial phone calls for UM Nurse to follow + Prioritizes work as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring it… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... ensure compliance with utilization management policies. This role conducts admission and continued...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- University of Utah Health (Salt Lake City, UT)
- …advancement, and overall patient outcomes. **Responsibilities** + Applies approved utilization criteria to monitor appropriateness of admissions with associated ... or third-party payer. + Alerts and discusses with physician/provider and case manager /discharge planner when patient no longer meets medical necessity criteria for… more
- Molina Healthcare (Everett, WA)
- …(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
- City and County of San Francisco (San Francisco, CA)
- …staff, ensuring effective operations and continuous performance improvement across the department . The Health Information Management (HIM) Manager , Ambulatory ... The Department of Public Health prioritizes equitable and inclusive...coding and compliance with regulatory requirements in coordination with Utilization Management, Patient Financial Services, and Revenue Integrity. +… 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 ... time-we'd love to meet you! The RN - Care Manager is a health care professional with experience and...indicators including LOS, cost per case, avoidable days, resource utilization , readmission rates, concurrent denials, and appeals .… more
- Sharp HealthCare (San Diego, CA)
- …documents as appropriate in the electronic medical record and provides information to the department head as indicated. + Utilization review and utilization ... **Facility:** Sharp Memorial Hospital **City** San Diego ** Department ** **Job Status** Regular **Shift** Day **FTE** 1...1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager … more
- Mount Sinai Health System (New York, NY)
- …Experience Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. ... **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
- Guthrie (Sayre, PA)
- Summary The Denial, Appeal, and Audit Manager is responsible for the oversight and management of all payer denials, appeals , and audit processes within the ... of claim denials, effective appeal strategies, and proactive audit response. The manager leads a team of specialists, coordinates with internal departments, and… more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Manager Revenue Cycle position is responsible for the daily management of the staff and operations for one or more of the following areas ... to: medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This… more
- Hartford HealthCare (Farmington, CT)
- …Key responsibilities include timely investigation of DRG downgrades, submitting appeals , coordinating follow-up actions, and ensuring compliance with regulatory ... documentation to validate or appeal payer denials. . Prepare, document, and submit appeals for DRG denials, ensuring appeals are well-supported with clinical… more
- LA Care Health Plan (Los Angeles, CA)
- Technical Applications Manager II Job Category: Information Technology Department : IT Solutions Delivery Location: Los Angeles, CA, US, 90017 Position Type: Full ... safety net required to achieve that purpose. Job Summary The Technical Application Manager II reports to the Senior Manager Information Technology IT Solutions… more
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