- 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
- 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
- CVS Health (Phoenix, AZ)
- …activity as well as preparing for appeals audits. + Consults with manager on complex cases and interfaces with case managers, clinical supervisors, and ... + Assigns reviews to Medical Directors and enters all data related to appeals and case reviews into a database. + Participates in data and analysis of reports… more
- Molina Healthcare (Omaha, NE)
- …unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance… more
- Elevance Health (New York, NY)
- **Behavioral Health Medical Director-Psychiatrist Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required ... Saturday rotation, once a month.** The **Behavioral Health Medical Director-Psychiatrist Appeals ** is responsible for the administration of behavioral health medical… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **RN/ Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management ... term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager or...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as… more
- Mount Sinai Health System (New York, NY)
- **Job Description** RN/ Case Manager Mount Sinai West FT Days 8a-4p EOW The Case Manager (CM) will be responsible for all aspects of case management ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information to the payor, as… more
- GAP Solutions Inc (Arlington, VA)
- …inputs, report generation, and other work with both classified and unclassified case files. In addition, individuals will be expected to research, locate, and ... as related to all of DOHA's various types of case files. This work must be done in coordination...Defense Consolidated Adjudications Facility (CAF), the Navy Personal Security Appeals Board (PSAB), Air Force PSAB, WHS Correspondence Analysis… more
- Sharp HealthCare (San Diego, CA)
- …**Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager ... Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) - American Case...Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers.Review all cases with readmission… more
- Select Medical (Los Angeles, CA)
- …A Joint Venture with Cedars, UCLA, and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) - 8 hr shifts Registered Nurse (RN) ... at Cal Rehab have a high discharge to home rate. **Benefits of working as a Case Manager with us:** + Excellent Orientation Program + Paid Time Off (PTO) +… more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- …perspective and experience makes ConnectiveRx better than the sum of its parts. The Case Manager 's primary duty is to assist customers with chronic illnesses in ... by gaining access to their wellbeing needs, journey and treatment plan. The Case Manager collaborates and maintains consistent communications with internal and… more
- LifePoint Health (Rutherfordton, NC)
- …admitted to the hospital by facilitating initiation of care starting.2. The ED Case Manager starts initiation and utilization process, encouragement of use of ... discharge plans.5. Follows up with any denials through the appeals process; including RAC chart audit reviews. Emergency Department...appropriate areas of the hospital, ie outpatient.3. The ED Case Manager is responsible for monitoring and… more
- Bassett Healthcare (Cooperstown, NY)
- …health 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 ... and coordinates utilization management, care facilitation, and discharge planning functions. The Case Manager is accountable for a designated patient caseload… more
- LifePoint Health (Hickory, NC)
- *_Registered Nurse (RN), Clinical Case Manager PRN_* *_PRN/Days_* * * * * *Schedule:* Monday-Friday 7:30a-4:00p/8:00a-4:30p * *Your experience matters* Frye ... **Job:** **Nursing* **Organization:** ** **Title:** *Registered Nurse (RN), Clinical Case Manager PRN* **Location:** *NC-Hickory* **Requisition ID:**… more
- LifePoint Health (Hickory, NC)
- *_Registered Nurse (RN), Clinical Case Manager PRN_* *_PRN days_* ** ** *Schedule:* Monday-Friday 7:30a-4:00p/8:00a-4:30p * *Your experience matters* Frye ... **Job:** **Nursing* **Organization:** ** **Title:** *Registered Nurse (RN), Clinical Case Manager PRN* **Location:** *NC-Hickory* **Requisition ID:**… more
- Highmark Health (Monroeville, PA)
- …BSN **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association - ... + Case Management - American Board of Occupational Health Nurses (ABOHN) andCertified Case Manager (CCM) + Commission for Case Manager Certification… more
- Alameda Health System (San Leandro, CA)
- SLH Case Manager RN + San Leandro, CA + San Leandro Hospital + SLH Social Services + Part Time - Day + Care Management + $58.74 - $97.91 per hour + Req ... + Posted:August 12, 2025 **Summary** **JOB SUMMARY** The SLH Case Manager RN is responsible for providing...contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic… more
- Elevance Health (IN)
- **LTSS Service Coordinator ( Case Manager )** **Location:** Seeking candidates to work in Bartholomew County, Delaware County, Daviess County, Dubois County, Grant ... to client needs, and direct, hands-on engagement. The **LTSS Service Coordinator ( Case Manager )** is responsible for conducting service coordination functions… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Care Advocacy Case Manager RN Location: Remote Career Area: Health Services About Blue ... of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and tools. Care Advocacy… more
- Amergis (French Camp, CA)
- …$518.00 $924.00 $3,042.00 **Local Pay $75/hr** - No stipend pay The RN Case Manager is responsible for coordinatingcontinuum of care activities for assigned ... in state practicing + At least one year of Case Management experience preferred + Current CPR if applicable...nurse: We need someone that is current with Denials, Appeals and utilization review . If a candidate had… more
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