- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... and/or escalates denial when appropriate. Submits all (initial and/or appeals ) reviews and/or letters within contractual or regulatory timeframes. Collaborates… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
- Catholic Health Services (Melville, NY)
- …for services and coordinates utilization/ appeals management review. Assist Utilization and Appeals Manager in setting up communications with payors and/ or ... and facility departments. Develops/validates daily work lists for Utilization and Appeals Manager . Assist with all insurance and regulatory audits and provides… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging… more
- Public Storage (Plano, TX)
- …and preferred stocks trade on the New York Stock Exchange. **Job Description** The Senior Manager , Property Tax Appeals and Analysis, is a key member of the ... Public Storage tax team, responsible for strategically managing the property tax appeals process across a national portfolio. This position reports directly to the… more
- LA Care Health Plan (Los Angeles, CA)
- …required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory timelines by ... obtaining clarification on initial responses. (25%) Under the supervision of the Appeals and Grievance Manager , assist with soliciting non-clinical information… more
- CVS Health (Phoenix, AZ)
- …in data and analysis of reports regarding appeal activity as well as preparing for appeals audits. + Consults with manager on complex cases and interfaces with ... heart, each and every day. **Position Summary** + Processes appeals and ensures timely and accurate completion. + Maintains...to Medical Directors and enters all data related to appeals and case reviews into a database. + Participates… more
- State of Minnesota (St. Paul, MN)
- …join a legal team making a difference for Minnesotans! Reporting to the Paid Leave Appeals Manager , you're key to the overall success of our division. **Key ... + **Division/Unit** : Paid Family & Medical Leave / Appeals Hearings Unit + **Work Shift/Work Hours** : Day...that may be appealed to the Minnesota Court of Appeals . + **Timely Execution of Duties:** Must hold multiple… more
- State of Minnesota (St. Paul, MN)
- …join a legal team making a difference for Minnesotans! Reporting to the Paid Leave Appeals Manager , you're key to the overall success of our division. **Key ... + **Division/Unit** : Paid Family & Medical Leave / Appeals Hearings Unit + **Work Shift/Work Hours** : Day...that may be appealed to the Minnesota Court of Appeals . + **Timely Execution of Duties:** Must hold multiple… more
- Mount Sinai Health System (New York, NY)
- …as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status ... + Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements.../ Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and… more
- Garnet Health (Middletown, NY)
- …for the day to day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate processes, policies and ... Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of Clinical Documentation Integrity (CDI) and DRG Denials is responsible… more
- State of Minnesota (St. Paul, MN)
- …and receiving documents submitted for evidence. This position works within the Paid Leave Appeals unit and works with the Senior Manager of Appeals , ... within the Paid Leave Division of DEED, not limited to, but including, Appeals . The administrative functions include assisting with mailing, making calls to parties,… more
- The County of Los Angeles (Los Angeles, CA)
- …quality assessment and assurance monitoring processes; and handle informal complainant appeals . Health Facilities Program Manager , Nursing positions are required ... HEALTH FACILITIES PROGRAM MANAGER , NURSING Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4626091) Apply HEALTH FACILITIES PROGRAM MANAGER… more
- Elevance Health (Walnut Creek, CA)
- **Title: Grievance/ Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law._ The **Grievance/ Appeals Analyst I** is an entry level position in...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is...assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and cohesive unit with… more
- Elevance Health (Tampa, FL)
- **Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... accommodation is granted as required by law._ The **Nurse Appeals ** is responsible for investigating and processing and medical...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (Omaha, NE)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals… more
- Elevance Health (Durham, NC)
- **Medical Director-Pain Management/Anesthesia Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required ... as required by law. The **Medical Director Pain Management/Anesthesia Appeals ** is responsible for the review of appeals...and quality. + Work independently with oversight from immediate manager . + May be responsible for an entire clinical… more
- Munson Healthcare (Traverse City, MI)
- …and verbal communication skills. ORGANIZATIONAL RELATIONSHIP . Report to the Manager of Utilization Management and works closely with the Utilization Management ... and Appeals team . Interacts independently with all Munson Health...and sorts incoming communication to the Utilization Management and Appeals department, including faxes, emails, physical mail, and phone… more
Related Job Searches:
Appeals,
Appeals Grievance Manager,
Appeals Manager Department Utilization,
CHS Utilization Appeals Manager,
Case Manager Appeals,
Denials Appeals Manager,
Manager,
Manager Appeals Grievances,
Senior Manager Appeals Grievances,
Senior Manager Appeals Project