- CareFirst (Baltimore, MD)
- …of members for Commercial lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State and Federal Regulatory fines ... for Care Management. We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who...who is willing and able to work in a hybrid model. The incumbent will be expected to work… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager , Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & Grievances ... the safety net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General Operations ( Clinical ) is responsible for the… more
- Elevance Health (Independence, OH)
- ** Manager II Grievance/ Appeals -RN** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Hills ( _Must be within commutable distance to one of the listed ... an accommodation is granted as required by law._ The ** Manager II Grievance/ Appeals ** is responsible for management...clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and… more
- Elevance Health (Indianapolis, IN)
- **Nurse Appeals ** **Location: Indiana** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... onboarding and skill development. Please note that per our policy on hybrid /virtual work, candidates not within a reasonable commuting distance from the posting… more
- Elevance Health (FL)
- ** Appeals Medical Director - Medicare** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... onboarding and skill development. Please note that per our policy on hybrid /virtual work, candidates not within a reasonable commuting distance from the posting… more
- CenterWell (Denver, CO)
- …to preserve and recover revenue while maintaining the highest level of clinical and regulatory integrity and compliance. Manages the Denials Management data ... and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face,...+ Oversee the process for direction and support to clinical and operational leadership regarding Medicare and governmental audit… more
- Elevance Health (Cincinnati, OH)
- **Title:** Manager , Pharmacy Clinical Operations ( Clinical Configuration) **Location(s):** Mason, OH, Cincinnati, OH ** Hybrid :** This role requires ... the industry. **Build the Possibilities. Make an Extraordinary Impact.** The ** Manager , Pharmacy Clinical Operations ( Clinical Configuration)** responsible… more
- Garnet Health (Middletown, NY)
- …Health Medical Center. Responsibilities Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of ... to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet...day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement… more
- Elevance Health (Denver, CO)
- …Management Pharmacist ( Clinical Pharmacist) **Location(s):** Denver, CO, Las Vegas, NV ** Hybrid :** This role requires associates to be in-office 1 - 2 days per ... pharmacy benefits. By leveraging the power of new technologies, our strong, clinical -first lens and deep pharmacy expertise, we are actively defining our innovative… more
- Elevance Health (Grand Prairie, TX)
- ** Clinical Analytic Pharmacist** A proud member of the Elevance Health family of companies, **CarelonRx** (formerly IngenioRx) leverages the power of new ... technologies and a strong, clinical -first lens, to deliver member-centered, lasting pharmacy care. **Office...adaptable workplace. _Please note that per our policy on hybrid /virtual work, candidates not within a reasonable commuting distance… more
- Elevance Health (Seven Hills, OH)
- …pharmacy benefits. By leveraging the power of new technologies, our strong, clinical -first lens and deep pharmacy expertise, we are actively defining our innovative ... **Build the Possibilities. Make an Extraordinary Impact.** **Title** : Clinical Pharmacist (Prior Authorization) **Location(s):** + Indianapolis, IN + Mason,… more
- State of Colorado (Pueblo, CO)
- Patient Financial Services Manager - Program Management II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5191516) Apply Patient Financial ... Services Manager - Program Management II Salary $95,892.00 - $120,000.00...position is open to current Colorado residents only Weekly Hybrid Working Arrangements Minimum 2 days In Office and… more
- Fallon Health (Worcester, MA)
- …office 5 days/week from 8 am to 5 pm up to 6 months before working a hybrid schedule. Must be able to type 25 WPM.** **About us:** Fallon Health is a company that ... the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge,… more
- University of Michigan (Ann Arbor, MI)
- RN CASE MANAGER : University Hospital (Care Management) Apply Now **Job Summary** The RN Case Manager assesses, develops, implements, coordinates and monitors a ... care areas. The position is unique in that it combines clinical /quality considerations with regulatory/financial/utilization review demands. The position creates a… more
- Elevance Health (Gary, IN)
- **LTSS Service Coordinator (Case Manager )** **Location:** Seeking candidates located in Lake County Indiana. **_Please note that per our policy on hybrid /virtual ... needs, and direct, hands-on engagement. The **LTSS Service Coordinator (Case Manager )** is responsible for conducting service coordination functions for a defined… more
- Elevance Health (Costa Mesa, CA)
- ** Manager II Medical Management** **Location:** This role requires associates to be in-office **3** days per week, fostering collaboration and connectivity, while ... a dynamic and adaptable workplace. _Please note that per our policy on hybrid /virtual work, candidates not within a reasonable commuting distance from the posting… more
- Elevance Health (Gallipolis, OH)
- **LTSS Service Coordinator (Case Manager )** **Candidates should live in one of the following counties:** Auglaize, Coshocton, Defiance, Gallia, Harrison, Holmes, ... and direct, hands-on engagement. _Please note that per our policy on hybrid /virtual work, candidates not within a reasonable commuting distance from the posting… more
- International Medical Group (Indianapolis, IN)
- …-- Must have an active RN license in good standing in Indiana. + Location: Hybrid or Remote working options. + Corporate office is in Indianapolis, IN. + Relocation ... status (eg, H-1B or TN status) for this position. JOB SUMMARY The Case Manager will evaluate medical necessity, appropriateness, and efficiency of the use of health… more
- Sanford Health (SD)
- …**Salary Range:** $24.00 - $38.50 **Department Details** This position may be hybrid or remote **Job Summary** Responsible for performing advanced level work related ... to appeals and denials by conducting a comprehensive review of clinical documentation, writing compelling arguments based on the clinical documentation, and… more
- Elevance Health (Miami, FL)
- ** Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management** **Virtual** : This role enables associates to work virtually ... onboarding and skill development. _Please note that per our policy on hybrid /virtual work, candidates not within a reasonable commuting distance from the posting… more