- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This ... position reports to the Clinical Program Manager . This job description is not designed to cover...within managed care setting. + 3+ years' experience in clinical nurse setting preferred. + Grievance experience… more
- LA Care Health Plan (Los Angeles, CA)
- …the needs of LA Care's culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the A&G Leadership in identification ... Supervisor, Appeals and Grievances Clinical Operations RN...Must be able to work independently. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California License… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...clinical guidelines; refers questionable cases to the CM Manager or physician advisor for determination. 3. Collaborates and… more
- UNC Health Care (Chapel Hill, NC)
- …unique communities we serve. RN Utilization Manager position specifically for a Utilization Manager / Clinical Appeals Nurse . This person is based at ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff… more
- WesleyLife (Urbandale, IA)
- …joy for yourself and those you serve. A Typical Day for a Home Health Clinical Manager with WesleyLife at Home/Home Health: **Mentorship and Team Development** - ... seek candidates who prioritize joy in their daily work. Whether you're in a clinical , hospitality, or administrative role, WesleyLife offers opportunities to create… more
- City and County of San Francisco (San Francisco, CA)
- …Center, and over 15 primary care health centers. Under general supervision, the Nurse Manager -Long Term Care/Geriatric Nursing supervises the delivery of patient ... general acute care/skilled nursing facility with rehabilitation services. The 2322 Nurse Manager -Long Term Care/Geriatric Nursing performs the following… more
- Trinity Health (Syracuse, NY)
- …appropriate discharge plan for the patients within their service area. The Registered Nurse Manager is accountable for applying positive managerial strategies to ... by the St. Joseph's Health Mission and Values, the manager of Utilization Review is responsible for the planning,...of health care resources via pre- and post-service review, appeals and program and network referrals. The scope of… more
- State of Colorado (Denver, CO)
- …and level of staffing during own shift and proximal shifts. In collaboration with Nurse Manager and treatment team, recommends a change in program scheduling to ... During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision...coaching and direction in the moment, and recommends to Nurse Manager strategies to improve staff skills… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4394165) Apply CDOC Registered Nurse ( Nurse I) ... $7,442.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 2/2024 Department Department of Corrections Division Clinical and… more
- State of Colorado (CO)
- …CAA Nurse III 2/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 02/08/2024 Closing Date 6/30/2024 4:00 PM ... CDOC Nurse Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4383689) Apply CDOC ...+ Benefits + Questions Department Information $25,000Hiring Incentives for Clinical Professionals: Payout will be 50% of the hiring… more
- International Medical Group (Indianapolis, IN)
- …outpatient management of assistance cases. + Knowledge of the Non-certification process and Appeals process including logs and time frames. + Participate in the on ... and/or seminars. + Support and participate in Quality Management activities. + Utilize clinical support tools as indicated. + Maintain a working knowledge of the any… more
- Point32Health (MA)
- …click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Program Manager is a Registered Nurse who performs program oversight activities ... effective working relationships across partnering business areas and external entities. The Clinical Program Manager is a highly motivated individual with an… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve medically necessary… more
- CommonSpirit Health Mountain Region (Westminster, CO)
- …you flourish and leaders who care about your success. Join our team as a Registered Nurse (RN) Clinical Coordinator. In the role of RN Clinical Coordinator ... you will: + Actively support department director/ manager by coordinating clinical and department activities for the unit including shift charge, department… more
- Trinity Health (Des Moines, IA)
- …+ Supports organizational evidence-based practice, innovation and research. + Assists the manager in the clinical contracting process, consistent with legal and ... time **Shift:** Day Shift **Description:** The purpose of the Clinical Integration Specialist is to assist and support the...Promise in behaviors, practices, and decisions. + Assists the manager in areas of oversight of quality, patient safety… more
- The Cigna Group (Nashville, TN)
- …related issues, implications and decisions. The Case Management Analyst reports to the Supervisor/ Manager of Appeals and will coordinate and perform all appeal ... **Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst** We...as well as research and provide a written detailed clinical summary for the Plan Medical Director. + Determine… more
- HCA Healthcare (Greenwood Village, CO)
- …colleagues invested over 156,000 hours impacting our communities. As a Hospice Director of Clinical Services with HealthONE Hospice & Family Care, you can be a ... manager in an organization that is devoted to giving!...Come join our team as a Hospice Director of Clinical Services. We care for our communities and employees!… more
- Alameda Health System (Oakland, CA)
- Manager , Care Management + Oakland, CA + Highland General Hospital + HGH Care Coordination + Full Time - Day + Management + Req #:38499-28188 + FTE:1 + ... paid time off plans **Role Overview:** Alameda Health System is hiring! The Manager of Care Management is responsible for the day-to-day operations of facility wide… more
- Children's Mercy Kansas City (Kansas City, MO)
- …the walls of our hospital. Overview The BSN, Admission and Denials Care Manager utilizes clinical expertise, insurance knowledge, business know-how, and high ... level of care: + Provide evidence-based clinical guideline and supporting clinical information to support successful appeals of all denials. + Coordinate… more
- Highland General Hospital (Oakland, CA)
- …in multiple plans. + Generous paid time off plans Role Overview: The Manager of Care Management at Highland is responsible for the day-to-day operations of ... compliance studies. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with...Perform all other duties as assigned. + Performs daily clinical rounds and monthly audit of charts on care… more