- Guardian Life (Columbus, OH)
- …with Group Disability claims experience to join our dynamic Appeals Team. The Appeals Case Manager II (ACM 2) is responsible for adjudicating assigned ... Readily share insights and learnings with claims colleagues. **Reporting Relationships:** As our Appeals Case Manager II, you will report to our Leader, … more
- Penn Medicine (Philadelphia, PA)
- …or Equivalent Experience:** + Bachelors degree in Nursing and 5+ years Working as a RN Case Manager and /or Appeals Coordinator required. We believe that the ... you living your life's work? **Summary:** + The Clinical Appeals Coordinator will play an essential role in maximizing...will provide oversight to the process and assist the Case Managers' at PAH in this important departmental process.… 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
- 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
- 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
- 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
- Molina Healthcare (Columbus, OH)
- …unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards. This position will support… 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
- Molina Healthcare (Columbus, OH)
- …unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified ... Monday-Thursday and Wed - Saturday._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for… 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 ... position is accountable for carrying out and documenting the appeals process for denied claims denied due to reasons...active nursing experience in acute care setting, coding, and/or case management + Three (3 ) years of experience… 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 ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Case Manager is responsible for all aspects of case management/ utilization review for an assigned group of inpatients, ED patients ... and identify the expected length of stay (ELOS). The case manager works collaboratively with physicians, social...with physicians and managed care companies on concurrent denial appeals * Communicates clinical information to the payor, as… more
- HCA Healthcare (Rochester, NH)
- …for life - and empowers their passion for patient care. Apply today for our Case Manager opportunity. **Job Summary and Qualifications** The Case Manager ... facilitating patient progression and transition through the continuum of care. The Case Manager facilitates and coordinates the efforts of the interdisciplinary… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Case Manager (CM) will be responsible for all aspects of case management for an assigned group of inpatients to determine the ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information to the payor, as… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible for functional and operational aspects of the Case Mgmt./Social Work ... corporate and hospital administrators, medical staff, and defined customers related to the Case Mgmt. system. The Manager Case Mgmt./Social Work position… more
- Sharp HealthCare (La Mesa, CA)
- …End Time** California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) - American Case Management Association (ACMA); ... Bachelor's Degree in Nursing; Certified Case Manager (CCM) - Commission for ...Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers.Review all cases with readmission… more
- Select Medical (Los Angeles, CA)
- …partnership between Cedars-Sinai, UCLA Health and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) - 8 hr shifts Registered ... at Cal Rehab have a high discharge to home rate. **Benefits of working as a Case Manager with us:** + Excellent Orientation Program + Paid Time Off (PTO) +… more
- Select Medical (Los Angeles, CA)
- …Joint Venture with Cedars, UCLA and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Registered Nurse (RN) or Social Worker (LCSW) **Per Diem** ... **Pay Rate: $66.00** **Benefits of becoming a Case Manager with us:** + Manageable ...negotiations of continued stay rationale, length of stays, and appeals process. Initiates activities to develop positive business relationships… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Nursing Clinical Manager (NCM) for Case Management is responsible for the day to day management of the Case Managers. This includes, ... staffing, employee performance evaluation, performance improvement, and staff education. The NCM Manager serves as a resource/mentor for Case Managers, Social… more
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