- RWJBarnabas Health (Oceanport, NJ)
- Manager , Appeals (Full- Time) Remote RoleReq #:0000200495 Category:Billing/Collections/Registration Status:Full-Time Shift:Day Facility:RWJBarnabas Health ... System Business Office, 2 Crescent Place, Oceanport, NJ 07757 Job Title: Manager Location: Barnabas Health Corp Department: Appeals Req#: 0000200495 Status:… more
- CareFirst (Baltimore, MD)
- …- State Licensure And/or Compact State Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred or + LNCC - Legal Nurse Consultant ... goals resulting in the full and fair review of appeals and grievances designed to achieve corporate objectives and...Science Nursing or related field, Legal Nurse Consultant, Certified Case Manager . **Knowledge, Skills and Abilities (KSAs)**… 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
- Molina Healthcare (Provo, UT)
- …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
- Aerotek (Tampa, FL)
- …Nurse - State Licensure And/or Compact State Licensure Upon Hire Req CCM - Certified Case Manager Upon Hire Pref LNCC - Legal Nurse Consultant Certified Upon ... **Description** PURPOSE: The Clinical Appeals Specialist completes research basic analysis and evaluation...and Federal regulations and mandates. + Organizes the appeal case for physician review by compiling clinical contractual medical… more
- Elevance Health (Roanoke, VA)
- …Able to work independently on assignments and under minimal guidance from the manager . + Prepare detailed work papers and present findings in accordance with ... report reopenings. + Under guided supervision, participate in completing more complex appeals related work: + Position papers + Jurisdictional Reviews + Maintaining… more
- Ochsner Health (New Orleans, LA)
- …Health System (OHS). Functions as a liaison with the department Vice President/ Manager of Regulatory Audits and ensures compliance with regulations and alternative ... experience in the delivery of patient care as an RN. Experience in Case Management, Utilization Review and/or Discharge Planning .either in the Acute Care… 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 ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...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 Inpatient** The Case Manager (CM) will be responsible for all aspects of case ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals + Communicates clinical information to the payor, as… more
- Robert Half Legal (Atlanta, GA)
- Description Robert Half is seeking a committed and experienced Case Manager with a strong background in Social Security Disability law. In this role, you will ... expertise will ensure that all aspects of their applications, appeals , and legal representation are handled with professionalism and...Requirements Qualifications: + 2+ years of experience as a case manager , paralegal, or in a similar… more
- State of Colorado (Pueblo County, CO)
- CDOC - Release Case Manager (LVCF) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4969762) Apply CDOC - Release Case Manager ... contained within the offender's electronic file and any prior case management notes, case plans, or progress...establish an eligible list for referral to the hiring manager for final consideration. Use of artificial intelligence (AI)… more
- Sharp HealthCare (La Mesa, CA)
- …Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Accredited Case Manager (ACM) - American Case Management Association (ACMA); ... Bachelor's Degree in Nursing; Certified Case Manager (CCM) - Commission for ...Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers.Review all cases with readmission… more
- Select Medical (Columbus, OH)
- …Hospital** A joint venture with Select Medical & OhioHealth **Columbus, OH** **RN Case Manager ** **(RN or MSW)** **$5,000 Sign-On Bonus** **Benefits of becoming ... a Case Manager with us:** + Manageable ...negotiations of continued stay rationale, length of stays, and appeals process. Initiates activities to develop positive business relationships… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible for functional and operational aspects of the Case Mgmt./Social Work ... corporate and hospital administrators, medical staff, and defined customers related to the Case Mgmt. system. The Manager Case Mgmt./Social Work position… more
- Select Medical (Los Angeles, CA)
- …partnership between Cedars-Sinai, UCLA Health and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Full Time - 8 hr shifts (on-site) **Schedule: ... 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
- Select Medical (Los Angeles, CA)
- …Joint Venture with Cedars, UCLA and Select Medical Century City / Los Angeles, CA Case Manager (CM) - 8 hr shifts (on-site) **Per Diem (variable schedule)** ... $66.00** 2,500 Sign on Bonus **Benefits of becoming a Case Manager with us:** + Manageable ...negotiations of continued stay rationale, length of stays, and appeals process. Initiates activities to develop positive business relationships… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Nursing Clinical Manager (NCM) for Case Management is responsible for the day to day management of the Case Managers. This includes, ... staffing, employee performance evaluation, performance improvement, and staff education. The NCM Manager serves as a resource/mentor for Case Managers, Social… 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
- Alameda Health System (San Leandro, CA)
- San Leandro Hospital Case Manager RN, Per Diem, Days, 8hoursFeatured Job + San Leandro, CA + San Leandro Hospital + SLH Social Services + Services As Needed / ... + Posted:May 21, 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. 3. Encourages patients to develop realistic… 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
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