- Memorial Hermann Health System (Pearland, TX)
- …want you to be a part of our team. Job Summary The purpose of the Case Manager position is to support the physician, primary medical homes, and interdisciplinary ... utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where… more
- Shelter House (Fairfax, VA)
- Summary of Position: Under the supervision of the Director, the Senior Case Manager leads a team in providing services to assist low-income working families who ... focus on increased earnings through job training and additional education. The Senior Case Manager leads the team in implementing services with a… more
- Mount Sinai Hospital (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, but ... staffing, employee performance evaluation, performance improvement, and staff education. The NCM Manager serves as a resource/mentor for Case Managers, Social… more
- Boston Childrens Hospital (Boston, MA)
- …5 years nursing experience required, pediatric experience preferred. Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. ... Massachusetts license as a Registered Nurse (RN) A certification as a Certified Case Manager (or other pediatric specialty certification like CPN or CCRN)… more
- Athens Health and Rehabilitation LLC (Huntsville, AL)
- Regional Case Manager - Covers facilities in North Alabama MDS (minimum data set) experience required NHS is seeking an experienced Regional Case Manager ... rehab services at the highest practicable level for each resident. Provides case management services for certain high-risk Medicare Part A residents to ensure… more
- Elevance Health (Indianapolis, IN)
- Anticipated End Date: Position Title: LTSS Service Coordinator ( Case Manager ) - Grant/Delaware County Job Description: LTSS Service Coordinator ( Case ... to client needs, and direct, hands-on engagement. The LTSS Service Coordinator ( Case Manager ) is responsible for conducting service coordination functions for… more
- Sheppard Pratt (Amesbury, MA)
- …medical records for evidence of medical necessity and appropriateness of admission/continued stay, case review for appeals of payment denials, and the review and ... and appropriateness of patient admissions and continued stay. Conducts case review to determine justification for appeals ...Conducts case review to determine justification for appeals in response to actual or prospective payment denials.… more
- Northwell Health (Staten Island, NY)
- …information into department computer system. Communicates denial status to appropriate Case Manager . Collects appeal documentation from clinical team members ... Reviews status of retro clinical reviews and triages each case to next appropriate facilitator (ie Appeals ...each case to next appropriate facilitator (ie Appeals RN, Physician Advisor, etc.). * Facilitates processing of… more
- Northwell Health (Staten Island, NY)
- …information into department computer system. Communicates denial status to appropriate Case Manager . Collects appeal documentation from clinical team members ... Reviews status of retro clinical reviews and triages each case to next appropriate facilitator (ie Appeals ...each case to next appropriate facilitator (ie Appeals RN, Physician Advisor, etc.). Facilitates processing of managed… more
- The City University of New York (New York, NY)
- …Brooklyn offering associate and baccalaureate degrees, invites applications for a Manager of Student Advocacy and Accountability. Reporting to the Vice President ... for Enrollment Management and Student Affairs, the Manager of Student Advocacy and Accountability will, in addition to the CUNY Title Overview: Lead overall… more
- CentraState Healthcare System (Freehold, NJ)
- Overview Emergency Department (ED) Nurse Care Manager is responsible for establishing, coordinating, and maintaining the process to optimize patient throughput to ... care across the continuum for the ED. The Nurse Care Manager collaborates with the patient/family, multidisciplinary team, physicians, community resources and… more
- Premier Administrative Solutions (Clearwater, FL)
- Overview Claims Manager Servicing Health Insurance Policies or Benefits Summary: Premier Administrative Solutions (PAS) is a Third-Party Administrator (TPA) which ... the client's stated coverage. Join Premier Administrative Solutions as a Claims Manager and lead our Claims Department in delivering exceptional service to insurance… more
- Turner & Townsend (Los Angeles, CA)
- …staying true to the client's vision. Job Description Objective: The Safety Program Manager will serve as the on-site representative for the Director of Automated ... with federal, state, and local regulations where applicable. The Safety Program Manager will be responsible for evaluating technical and safety compliance and… more
- Guidehealth (Rockford, IL)
- …create electronic files and upload for the EDI vendor to receive. Sort incoming appeals and upload to the Vendor for entry. Responsible for outgoing mail for letter ... Peace of Mind: We provide Life and Disability insurance for those "just in case " moments. Additionally, we offer voluntary Life options to keep you and your loved… more
- Children's Health (Dallas, TX)
- …degree or equivalent experience Pref LICENSES AND CERTIFICATIONS * Registered Nurse Req * Accredited Case Manager (ACM) or Certified Case Manager (CCM) ... required * At least 1 year Utilization Review or Case Management experience required * Appeals experience Pref * Experience with Interqual or Milliman Pref… more
- HANAC, Inc. (Astoria, NY)
- …client issues Identify the process to alleviate client issues Work with a case manager to complete required immigration paperwork Consult with staff attorney ... part of a team with the immigration attorney, Board of Immigration Appeals (BIA) accredited representative, and support staff. The Immigration Paralegal will assist… more
- Healthier Mississippi People (Jackson, MS)
- …Accountable to perform utilization management services for designated patient case load, including prospective, concurrent, retrospective, and denial management ... quality of care issues identified during the um process to the appropriate manager . To perform job duties in accordance with the medical center's purpose. Knowledge,… more
- Hackensack Meridian Health (Hackensack, NJ)
- …iii. Clarifying ambiguous or conflicting documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate patient status ... but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and transitions of care, as outlined in the responsibilities… more
- University of Denver (Denver, CO)
- …persistence initiatives, undergraduate academic advising, academic standards, and academic appeals , and maintains institutional accreditation. As an educational and ... Academic Standards Committee, overseeing the outreach plan for each case . The role requires a collaborative and strategic thought...regarding this plan will be determined with the hiring manager and are dependent on the division and team… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and ... to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and...work. On the job or formal training in certified case management, denial and appeals management from… more
