- 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
- VNS Health (Manhattan, NY)
- …the day to day management of clinical appeals review processes within Appeals & Grievances Department . + Manages the intake, investigation and resolution of ... of members experience with A&G. + Tracks grievances and appeals that are in process in the department...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… more
- University of Washington (Seattle, WA)
- …PATIENT FINANCIAL SERVICES Department ** has an outstanding opportunity for a **CLINICAL APPEALS AND DISPUTES NURSE** **Work Schedule** + 100% FTE + 100% Remote + ... Req #: 239052 Department : UW MEDICINE - PATIENT FINANCIAL SERVICES Posting...chart auditor, certified professional in utilization review(or utilization management or healthcare management), certified case manager… more
- Elevance Health (Los Angeles, 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** **Location:** This position will work...requirements. + As such, the analyst will strictly follow department guidelines and tools to conduct their reviews. +… more
- Elevance Health (Richmond, VA)
- …post service grievances and appeals requests in the Enterprise Grievance & Appeals Department from customer types (ie member, provider, regulatory, and third ... **Title: Grievance/ Appeals Analyst II** **Location:** This position will work...requirements. + As such, the analyst will strictly follow department guidelines and tools to conduct their reviews, and… 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
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Hackensack Meridian Health (Hackensack, NJ)
- …determinations - OBS vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based Appeals Management e. ... documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate...e. Provides professional support to the functions within the Utilization Management Department f. Provides periodic written… more
- The Mount Sinai Health System (New York, NY)
- …to insure patient admission is approved Identifies and refers to the UM Manager &/or Administrator and/or Physician problematic utilization and quality issues ... Responsible for the maintenance of accurate data for approvals, denials and appeals (in coordination with UM Manager and management). Prioritizes insurance… more
- Billings Clinic (Billings, MT)
- …80 hours (Non-Exempt) Starting Wage DOE: $35.34 - 44.18 Under the direction of department leadership, the Utilization Review/ Management RN. This position is to ... cases that require second level review to Physician Advisor, Manager , and Director per department process or...to department leadership and Physician Advisor, per department process or procedure Insurance and Utilization … more