- PharmaCord (Lexington, KY)
- …Acquisition team immediately at ###@pharmacord.com When you join the team as an Executive Case Manager , you'll have the opportunity to make a difference in the ... ensuring their prescriptions or cases are handled in a timely manner. An Executive Case Manager has the ability to translate knowledge into patient friendly… 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 ... of medically complex Medicaid members. Through collaborative efforts the Case Manager will identify the medical and...to maintain cost-effectiveness and manage Medical Loss Ratio (MLR). Appeals & Denials: Participate in the appeals … more
- PharmaCord (Jeffersonville, IN)
- …Acquisition team immediately at ###@pharmacord.com When you join the team as the Bilingual Case Manager , you'll have the opportunity to make a difference in the ... our Benefits & Perks below to learn more! A typical day as a Bilingual Case Manager will include ownership of your patients cases from initiation to closure… 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:August 6, 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
- 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
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …the globe. **Exciting Opportunity at MSK:** Are you passionate about using your Case Management experience to support Oncology Patients? The MSK Case Management ... for evaluating and responding to clinical and administrative denials referred to Case Management Department for appeal. You will participate in the daily management… more
- Hawaiian Electric (Honolulu, HI)
- …on all aspects of litigation matters from case inception to judgment and appeals . Role: Manager Number of Vacancies: 1 Location: Honolulu - Oahu Hiring ... Hawaiian Electric Company has 1 Management vacancy available. (Role: Manager ) This posting seeks to fill at either the...commercial, contract, personal injury, and property damage claims, from case inception to judgment and appeals ; advising… more
- Ralliant (Albany, NY)
- **Job Title:** Product Manager **Location:** Remote, USA **Job Summary:** As a key contributor within Hengstler-Dynapar, the **Product Manager ** will guide the ... aligns with the company's business objectives while collaborating cross-functionally. The Product Manager will work closely with all functions within our company to… more
- Home Depot (Atlanta, GA)
- …enrollment process. + Manages the review of all health and welfare plan appeals and the review and resolution of all customer service and administration issues. ... and call center. + Selects, develops and motivates assigned staff. **Direct Manager /Direct Reports:** + Typically reports to Sr Manager Benefits Administration.… more
- Jobleads-US (Chicago, IL)
- …Identifies patterns of billing errors and works collaboratively with department manager and outside entity to improve processes as needed. Provides guidance ... write-off and provide appropriate justification and documentation. Denials and appeals follow-up including root cause analysis to reduce/prevent future denials.… 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
- HCA Healthcare (Nashville, TN)
- …School diploma or GED required; Associate's Degree preferred. + 1 year of Case Manager , Insurance utilization and/or hospital experience preferred. + Relevant ... an organization that invests in you as a Clinical Appeals Specialist Medicare RN or LPN? At Parallon, you...a difference. We are looking for a dedicated Clinical Appeals Specialist Medicare RN or LPN like you to… 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 (Walnut Creek, CA)
- **Behavioral Health Medical Director-Psychiatrist Appeals ** **Location:** California. 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
- 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
- Amergis (French Camp, CA)
- Salary: $3242 / Week The RN Case Manager is responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of ... be at least 18 years of age ?? Hospital Case Manager RN - Acute Care |...Management experience ? Key Responsibilities: + Discharge Planning + Appeals & Denials + Utilization Review + InterQual assessments… more
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