- Walmart (Bentonville, AR)
- …claim resolution and support injured associates and customers throughout the process. The ** Case Manager II ** is responsible for investigating, evaluating, ... process. + Establish timely and accurate reserves; Escalate claims to the Claims Manager ...customers or their attorney. + Prepare for and present claims during roundtable and serious case reviews… more
- USAA (Chesapeake, VA)
- …part of what truly makes us special and impactful. **The Opportunity** As a dedicated ** Claims Litigation Manager - Section II ** , you will be responsible for ... to include serious injury or property damage arising from Section II liability, questionable damages, questionable liability and questionable coverage issues. +… more
- State of Massachusetts (Boston, MA)
- …deliver program integrity. *What you'd do:* Lead Claims Examiner/Job Service Representative II , who reports to the Senior Manager of Benefit Operations & ... *Lead Claims Examiner/Job Service Representative II | Department...Job Service-Representative I's on fact-finding and the resolution of case issues. Interpret and explain relevant laws, regulations, policies… more
- Clark County, NV (Las Vegas, NV)
- …to the PGCM supervisor. Estate Case Manager I: $30.38 - $44.84 Hourly Estate Case Manager II : $32.77 - $48.43 Hourly The Estate Case Manager ... the successful candidate will be non-competitively promoted to Estate Case Manager II . This examination...client in legal proceedings. + Arranges for payment of claims against the client or estate. + Conducts interviews… more
- Elevance Health (Atlanta, GA)
- **Nurse Case Manager II ** Location(s): California, Colorado, Nevada, Washington State **Virtual:** This role enables associates to work virtually full-time, ... 11:30 AM to 8:00 PM (local time) The **Nurse Case Manager II ** responsible for...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager II ** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II ** is responsible...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Elevance Health (Louisville, KY)
- **Telephonic Nurse Case Manager II ** **Hours: Monday - Friday 9 - 5:30 pm EST, plus 3 times a month 11:30 - 8 pm EST.** **Location:** This role enables ... therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II ** is responsible...reimbursement, as applicable. Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Sutter Health (Burlingame, CA)
- …patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely ... management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and… more
- AO Smith (Lebanon, TN)
- Regional Field Service Manager II Date: Oct 7, 2025 Location(s): Lebanon, TN, US, 37090 Company: A. O. Smith Corporation PRIMARY FUNCTION: Regional field service ... SCOPE OF RESPONSIBILITY: Position reports to the Field Service Engineering Manager SPECIFIC DUTIES/ACCOUNTABILITIES(List in order of importance) + Aligned with… more
- Baylor Scott & White Health (Dallas, TX)
- …Summary** + Under the Safe Choice Claims Manager , the Safe Choice Claims Specialist II reviews, studies, and processes assigned claims within their ... efficient service while protecting the organization's assets. + The Claims Specialist II 's main duty involves using...and coordinate training with HR team. + Work with Claims Manager for improvements in processes to… more
- State of Massachusetts (Boston, MA)
- …or suitability is questionable or difficult to determine. 7. Prepare accurate case notations within claims management system which contain accurate, specific, ... * Claims Examiner/Job Service Representative I| Department of Family...Examiner/Job Service Representative I, who reports to the Senior Manager of Benefit Operations & Program Integrity is based… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …compliance and regulatory requirements. Primary activities include substantiating referrals, case planning and research, conducting onsite or desk audits, clinical ... in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned,… more
- Sutter Health (Oakland, CA)
- …**CERTIFICATION & LICENSURE** + RN-Registered Nurse of California Required + Certified Case Manager (CCM) Preferred. **EXPERIENCE** + Minimum of 2 years ... patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely… more
- LA Care Health Plan (Los Angeles, CA)
- …Social Worker; current and unrestricted California License. Licenses/Certifications Preferred Certified Case Manager (CCM) Accredited Case Manager ... Care Management Specialist II Job Category: Clinical Department: Care Management Location:...skills and judgement. Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and… more
- Sutter Health (Modesto, CA)
- …patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely ... management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and… more
- LA Care Health Plan (Los Angeles, CA)
- Authorization Technician II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: ... net required to achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative… more
- Elevance Health (Mason, OH)
- …a schedule of Wednesday - Sunday or Thursday - Monday. The **Transplant Nurse II ** will be responsible for providing case and/or medical management for members ... **Transplant Nurse II ** **Location:** Virtual: This role enables associates to...preparation for advancement to the senior level. Within the case management role will within the scope of licensure… more
- US Tech Solutions (Chesapeake, VA)
- …all levels to enable decision making at most appropriate level **Duties:** + Nurse Case Manager is responsible for face to face and telephonically assessing, ... and multiple diagnoses that impact functionality. + Reviews prior claims to address potential impact on current case... claims to address potential impact on current case management and eligibility. Assessments include the member's level… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …Documents below. The Miami VAMC is recruiting for two Registered Nurse - Risk Manager , who are responsible for the documented outcomes of the program. The RN Risk ... Manager demonstrates sound decision-making, judgment, and possesses excellent interpersonal...data and electronic systems that support incident, reviews, and claims management processes. Initiates and leads interdisciplinary teams that… more
- The County of Los Angeles (Los Angeles, CA)
- MANAGER , AUTOPSY OPERATIONS AND SUPPORT SERVICES Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4670156) Apply MANAGER , AUTOPSY ... Forensic Technician (https://www.governmentjobs.com/careers/lacounty/classspecs/1065384?keywords=Supervising%20Forensic%20Technician%20&pagetype=classSpecifications) for Los Angeles County. Option II : Four years of experience assisting pathologists in… more