- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews ... from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… more
- Catholic Health Services (Melville, NY)
- …requests for services and coordinates utilization / appeals management review. Assist Utilization and Appeals Manager in setting up communications with ... Managers, physician advisors and facility departments. Develops/validates daily work lists for Utilization and Appeals Manager . Assist with all insurance… 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, ... 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
- Elevance Health (Walnut Creek, 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
- Molina Healthcare (Omaha, NE)
- …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
- Munson Healthcare (Traverse City, MI)
- …customer service/interpersonal skills 6. Monitors and sorts incoming communication to the Utilization Management and Appeals department , including faxes, ... verbal communication skills. ORGANIZATIONAL RELATIONSHIP . Report to the Manager of Utilization Management and works closely... Utilization Management and works closely with the Utilization Management and Appeals team . Interacts… more
- Dayton Children's Hospital (Dayton, OH)
- …- OhioDepartment: Utilization Review TeamSchedule:Full timeHours:40Job Details:Reporting to the Manager of Utilization Management and in partnership with the ... below, may also be assigned other duties as required. Department Specific Job Details: Education + Completion of accredited...in a hospital required + 3-5 years as progressive utilization review nurse and knowledge of payers and managed… 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
- Mount Sinai Health System (New York, NY)
- …Nurse denial phone calls for UM Nurse to follow + Prioritizes work as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring it… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Manages the utilization of referral services. Enhances quality of care by assuring compliance with policies, including safety, ... **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages policies… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …of VHA and industry best standards. Responsibilities Responsibilities of the RUR Nurse Manager (NM) include, but are not limited, to the following: RUR Nurse ... Manager is accountable to the Consolidated Patient Account Center...cases to validate related care for reimbursement. Conducts clinical appeals as required by the third-party payers to overturn… 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
- AmeriHealth Caritas (Philadelphia, PA)
- …provides organizational leadership in the operational areas of care management, utilization review, appeals , quality improvement and related policy and ... practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The following… 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
- 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 EOW...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… 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
- Bassett Healthcare (Cooperstown, NY)
- …and reporting of resources and financial indicators including LOS, excess days, resource utilization , denials and appeals , swing bed statistics. + Uses data to ... and enjoy the best quality of life possible. What you'll do The Case Manager RN supports the physician and interdisciplinary team in facilitating patient care, with… more
- State of Colorado (Canon City, 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 ... CDOC - Business Manager (Canon City) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5056915) Apply CDOC...Time Job Number CAA Canon 3441 Bus Mgr 09.2025 Department Department of Corrections Opening Date 08/26/2025… 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 ... Accountant III - Payroll Manager - Youth Services & Hospitals Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5050742) Apply Accountant III -… more
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