- BronxCare Health System (Bronx, NY)
- …Management Position Type Regular Full-Time Division Bronxcare- Yonkers Max USD $97,125.00/Yr. Shift Day Shift Department : Name Appeals Department (BHCS) ... the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews ... payors for additional clinical documentation. | Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… more
- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals (RN)to lead the daily operations of our ... management of clinical appeals review processes within Appeals & Grievances Department . + Manages the...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… more
- The Cigna Group (Nashville, TN)
- …related issues, implications and decisions. The Case Management Analyst reports to the Supervisor/ Manager of Appeals and will coordinate and perform all appeal ... not limited to: + Must have experience in Medicare Appeals , Utilization Case Management or Compliance in...applicable and then if necessary, route to the proper area/ department for their review and decision/response + Complete necessary… more
- Elevance Health (Richmond, VA)
- … 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** **Location:** This position will work...requirements. + As such, the analyst will strictly follow department guidelines and tools to conduct their reviews. +… more
- Elevance Health (Las Vegas, NV)
- … 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** **Location:** This position will work...requirements. + As such, the analyst will strictly follow department guidelines and tools to conduct their reviews. +… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department : CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... Required: Knowledge of state, federal and regulatory requirements in Appeals /Care/Case/ Utilization Management/Quality. Strong verbal and written communication… more
- Molina Healthcare (Tampa, FL)
- …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
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE: The… more
- AdventHealth (Tampa, FL)
- …as a Primary Stroke Center. **The ro** **le you'll contribute:** The Divisional Manager of Utilization Management (UM) is a registered nurse, who works ... for the strategic direction setting, management, continuous improvement, and maintenance Utilization Management team. The Divisional Manager assists the UM… more