- 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, ... net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances...in a manner consistent with regulatory requirements from the Department of Managed Health Care, Department of… more
- CareFirst (Baltimore, MD)
- …+ Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used ... contribution programs/plans (all benefits/incentives are subject to eligibility requirements). ** Department ** MD Medicaid and DSNP Appeals **Equal Employment… more
- Molina Healthcare (Provo, UT)
- …Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training, leadership and mentoring for less ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...has been made or upon request by another Molina department to reduce the likelihood of a formal appeal… more
- Guardian Life (Bethlehem, PA)
- …serve as clinical subject matter expert in all lines of business (STD/LTD/ Appeals ) and products, action planning management, and Guardian systems. This incumbent ... opportunities. This individual will work with the Clinical Team Manager to drive performance and ensure the team meets...+ A minimum of 3+ years of (STD, LTD, Appeals ) claim experience, minimum of 2 years disability experience… more
- Ochsner Health (New Orleans, LA)
- …reimbursement to Ochsner Health System (OHS). Functions as a liaison with the department Vice President/ Manager of Regulatory Audits and ensures compliance with ... today!** This job applies clinical expertise as well as knowledge of utilization and discharge planning criteria to review medical information of prior hospitalized… more
- Beth Israel Lahey Health (Burlington, MA)
- …Officer as part of an integrated Revenue Cycle model. + Ensures the Utilization Review department maintains documented, up-to-date policies and procedures and ... a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for determining… more
- Children's Mercy Kansas City (Kansas City, MO)
- …review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital performance ... to integrated inpatient teams; assists Director in the management of department ; including personnel and fiscal management and development of, and training… more
- Children's Hospital Boston (Boston, MA)
- …Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard ... experience required, pediatric experience preferred. + Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. Licensure/… more
- AdventHealth (Glendale Heights, IL)
- …and financial indicators including LOS, cost per case, avoidable days, resource utilization , readmission rates, concurrent denials, and appeals . *Uses data to ... 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...UM RN is responsible to document findings based on department and regulatory standards. When screening criteria does not… more
- Ochsner Health (Lafayette, LA)
- …the daily operations of all assigned divisions within the case management department in collaboration with the case management and social services leadership. ... systems (CMS) regulations, compliance and quality metrics. Experience managing denials and appeals of all payer cases in a timely and organized manner. Preferred… more
- Alameda Health System (Oakland, CA)
- Manager , Care Management + Oakland, CA + Highland General Hospital + HGH Care Coordination + Full Time - Day + Management + Req #:38497-28187 + FTE:1 + Posted:March ... at Highland is responsible for the day-to-day operations of facility-wide utilization , discharge planning and care coordination. **DUTIES & ESSENTIAL JOB… more
- Sharp HealthCare (La Mesa, CA)
- …documents as appropriate in the electronic medical record and provides information to the department head as indicated. + Utilization review and utilization ... **Facility:** Grossmont Hospital **City** La Mesa ** Department ** **Job Status** Regular **Shift** Day **FTE** 1...1 **Shift Start Time** **Shift End Time** Accredited Case Manager (ACM) - American Case Management Association (ACMA); Bachelor's… more
- Mount Sinai Health System (New York, NY)
- …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years? experience as a ... **Job Description** **RN/Case Manager Mount Sinai West FT Days 8a-4p Inpatient**...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Mount Sinai Health System (New York, NY)
- …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years? experience as a ... **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- City and County of San Francisco (San Francisco, CA)
- …. Under general direction, the Port's Senior Waterfront Property Manager is responsible for marketing, leasing and managing the Port's ... within the parameters of a regulatory environment. The Senior Property Manager is also responsible for carrying out, interpreting and coordinating existing… more
- Houston Methodist (Sugar Land, TX)
- …incidental overtime and overtime percentage, and other areas according to department specifications. + Manages utilization management (UM) programs including ... At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible...functional and operational aspects of the Case Mgmt./Social Work department , an integrated, interprofessional department which supports… more
- CareOregon (Portland, OR)
- …Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Clinical Operations Manager Department Clinical Operations Exemption Status Exempt Requisition # ... and partners to problem solve issues and improve workflows. + Monitor outlier utilization and communicate with Finance department and reinsurer to ensure… more
- LifePoint Health (Rutherfordton, NC)
- …through the appeals process; including RAC chart audit reviews. Emergency Department (ED) Case Management1. Serves as a gatekeeper of patients being admitted to ... the hospital by facilitating initiation of care starting.2. The ED Case Manager starts initiation and utilization process, encouragement of use of reimbursable… more
- State of Colorado (Denver, CO)
- …ten (10) calendar days from your receipt of notice or acknowledgement of the department 's action. For more information about the appeals process, the official ... Fiscal Manager for FEAD Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4972395) Apply Fiscal...Job Type Full Time Job Number IHA 05811 06/12/2025 Department Colorado Department of Human Services Division… more
- State of Colorado (Denver, CO)
- …ten (10) calendar days from your receipt of notice or acknowledgement of the department 's action. For more information about the appeals process, the official ... Assistant Nurse Manager - Nurse III - Colorado Mental Health...Job Type Full Time Job Number IIC 05943 06/06/2025 Department Colorado Department of Human Services Division… more
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