- Guardian Life (Columbus, OH)
- Grow your career with Guardian in our newly created opportunity as a **Claim Case Manager II , Supplemental Health** ! In a culture where "People Count," "We ... decisions via telephone and in writing. + Prioritize and review new claims to adhere to established departmental turnaround times. + Meet productivity requirements… more
- Marriott (Costa Mesa, CA)
- …Full-Time **Located Remotely?** N **Relocation?** N **Position Type** Management **JOB SUMMARY** A Claims Adjuster II is responsible for the timely, good faith ... and complexity of Worker's Compensation and General Liability cases as determined by Claims Unit Manager .) **Expected Contributions** + Investigate claims … more
- Elevance Health (Richmond, VA)
- **"Telephonic" Nurse Case Manager II ** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point ... 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. **Minimum Requirements:** + Requires a… more
- Elevance Health (Indianapolis, IN)
- …proximity (1-hour commute and a 50-mile radius) to an Elevance Health Pulsepoint. The **Nurse Case Manager II ** is responsible for care management within the ... is providing services in multiple states. **Preferred Experience** Certification as a Case Manager is preferred. Discharge planning experience is a strong… more
- Elevance Health (Indianapolis, IN)
- …report to a Pulsepoint once a week (subject to future change). The **Nurse Care Manager II ** is responsible for care management within the scope of licensure for ... as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of...services in multiple states. **Preferred Experience** Certification as a Case Manager is preferred. BS in a… more
- Houston Methodist (Nassau Bay, 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
- Sutter Health (San Francisco, 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
- Sutter Health (Castro Valley, 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)
- …Worker; current and unrestricted California License. Licenses/Certifications Preferred Certified Case Manager (CCM) Required Training Physical Requirements Light ... 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 (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
- HCA Healthcare (Lone Tree, CO)
- …in this role. The typical candidate is hired below midpoint of the range. **RN Case Manager ** **Thursday - Sunday Weekend Shift 8 and 10 hour shifts** ... any other healthcare provider. We are seeking a(an) RN Case Manager to join our healthcare family....acute care setting. + Performs telephonic clinical reviews with claims insurance personnel to facilitate reimbursement for the delivery… more
- BlueCross BlueShield of Tennessee (Knoxville, TN)
- …language and reimbursement methodologies, managed care business processes, case \-mix adjustment, medical terminology, utilization management and applications for ... claims payment, required\. _License_ + Valid Driver's License **Job Specific Requirements:** + Needs to be located in the Johnson City OR Knoxville area OR in… more
- LA Care Health Plan (Los Angeles, CA)
- …to develop and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service ... Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full… more
- LA Care Health Plan (Los Angeles, CA)
- …Active, current and unrestricted California License Licenses/Certifications Preferred Certified Case Manager (CCM) Required Training Physical Requirements Light ... to develop and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service… more
- Arizona Public Service (Phoenix, AZ)
- HR Service Center Associate I / II | HR Services/Operations Apply now " Date: May 17, 2024 Location: PHOENIX, AZ, US, 85004-3903 Company: APS Our present and future ... Other and Succeed Together. Summary HR Service Center Associate I/ II | HR Services/Operations - Join our dynamic team...with the goal of resolving at first contact. Owns case management process which includes opening, managing escalation and… more
- ThermoFisher Scientific (Tewksbury, MA)
- …**Region of coverage:** Global **Reports To:** Global Technical Support Manager **Group/Division:** Analytical Instruments Group (AIG) / Chemical Analysis Division ... (CAD) **Career Band:** Band 5 (Technical Support Specialist II ) **Product Line:** Product Inspection **Key Responsibilities:** + Responsible for providing technical… more
- CAMBA (Brooklyn, NY)
- …the ability to recognize, diffuse, and/or avoid violent situations. Position: Supervisor II Reports To: Program Manager Location: 955 Flatbush Avenue, Brooklyn, ... clients with assistance is processing Crime Victims Board Compensation Claims ; individual and group counseling' support groups, housing assistance,...NY 11226 What The Supervisor II Does: + Provide individual counseling to victims of… more
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** Patient Access Concierge II - St. Peter's Hospital - Full Time - Days Greets patients and family ... authorizations (pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management/Utilization Review personnel, as needed. Obtains and verifies… more
- CareFirst (Reston, VA)
- **Resp & Qualifications** **PURPOSE:** The Quality Specialist II is responsible for examining and evaluating the accuracy of transactions in accordance with ... in projects. **ESSENTIAL FUNCTIONS:** + Audits assigned function (service, claims , enrollment) for accuracy, benefit payment, contract interpretation, and compliance… more
- Intrepid USA (Albany, GA)
- …Reporting . Outstanding Orders Reporting . Past Due Tasks Reporting . QA Manager Reporting . Visit Exception Reporting + Maintaining the patient's electronic medical ... requests for authorization to Authorization Department and/or obtains pre-authorization from case managers, state and county billers as needed. + Obtaining timely… more