- 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 best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials… more
- University of Washington (Seattle, WA)
- …Financial Services Department ** has an outstanding opportunity for a **Clinical Appeals and Disputes Nurse.** **WORK SCHEDULE** + 100% FTE + 100% Remote + ... Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared...auditor, certified professional in utilization review (or utilization management or healthcare management), certified case manager… more
- Elevance Health (Cerritos, CA)
- … Analyst I** is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post ... **Title: Grievance/ Appeals Analyst I** **Virtual:** This role enables associates...requirements. + As such, the analyst will strictly follow department guidelines and tools to conduct their reviews. +… more
- Huron Consulting Group (Chicago, IL)
- …our team as the expert you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, and ... Review Plan and the overall operation of the Utilization Management Department in accordance with federal,...Performance Tracking and Improvement: Provides analysis and reports of utilization , denials, and appeals KPIs, trends, patterns,… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 251212-5613FP-001 Location East Hartford, CT Date Opened 12/16/2025 12:00:00 AM Salary ... so, we invite you to learn more about joining our team as a Utilization Review Nurse Coordinator! The State of Connecticut (https://portal.ct.gov/) , Department … 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
- Sanford Health (Rapid City, SD)
- …time **Weekly Hours:** 40.00 ** Department Details** Join our team as a Utilization Review and Case Management Manager and lead a high-impact, data-driven ... value across the care continuum. You'll shape and execute utilization strategies that become the standard for how we...Summary** Responsible for the day to day oversight of department function both in terms of provision of service… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... concurrent and extended stay reviews. + Prepares and submits appeals to third party payors. + Maintains appropriate records...third party payors. + Maintains appropriate records of the Utilization Review Department . + Performs related duties,… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... ensure compliance with utilization management policies. This role conducts admission and continued...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- University of Utah Health (Salt Lake City, UT)
- …advancement, and overall patient outcomes. **Responsibilities** + Applies approved utilization criteria to monitor appropriateness of admissions with associated ... or third-party payer. + Alerts and discusses with physician/provider and case manager /discharge planner when patient no longer meets medical necessity criteria for… more
- Community Health Systems (Franklin, TN)
- … Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals activities. This ... timely authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities, assists… more
- Healthfirst (NY)
- …and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** + **Lead ... but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions** + **Partner… more
- Sharp HealthCare (San Diego, CA)
- **Facility:** Copley Drive **City** San Diego ** Department ** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Other; California ... care, SNF, home health, or hospice settings. + Experience as a case manager or discharge planner interacting with managed care payers. + Experience with InterQual… more
- Sharp HealthCare (San Diego, CA)
- …the discharge.He/she documents as appropriate in the EMR and provides information to the department head as indicated. + Utilization review and utilization ... **Facility:** Sharp Memorial Hospital **City** San Diego ** Department ** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time**… more
- Trinity Health (Philadelphia, PA)
- …experienced RN Care Manager to join our team in the Emergency Department ! **Schedule:** Full-time - Day Shift, 10-hour shifts **:** Under the general supervision ... of the Director of Care Coordination, the Emergency Department Care Manager assists physicians and the interdisciplinary team in facilitating the entry of… more
- Sharp HealthCare (San Diego, CA)
- …documents as appropriate in the electronic medical record and provides information to the department head as indicated. + Utilization review and utilization ... **Facility:** Sharp Memorial Hospital **City** San Diego ** Department ** **Job Status** Regular **Shift** Day **FTE** 1...1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager … more
- Mount Sinai Health System (New York, NY)
- …Experience Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. ... **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
- Guthrie (Sayre, PA)
- Summary The Denial, Appeal, and Audit Manager is responsible for the oversight and management of all payer denials, appeals , and audit processes within the ... of claim denials, effective appeal strategies, and proactive audit response. The manager leads a team of specialists, coordinates with internal departments, and… more
- State of Colorado (Colorado Springs, 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 ... ADMINISTRATOR IV: Clinical Contracts Manager (Colorado Springs, Colorado) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5167059) Apply … more
- University of Southern California (Arcadia, CA)
- …indicators including case mix, LOS, cost per case, excess days, resource utilization , readmission rates, denials, and appeals . + Collaborates and communicates ... and accurate information to payers. The role integrates and coordinates utilization management, care facilitation, and discharge planning functions. The Case… more
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