• CHS Utilization and Appeals…

    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 ... from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… more
    Catholic Health Services (07/19/25)
    - Related Jobs

  • Appeals Manager

    BronxCare Health System (Bronx, NY)
    Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and ... to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials… more
    BronxCare Health System (06/21/25)
    - Related Jobs

  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Yonkers, NY)
    …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
    Molina Healthcare (07/20/25)
    - Related Jobs

  • Utilization Review Manager

    Phoenix House (Wainscott, NY)
    …documentation as required by payors. The manager will supervise the Utilization Review Department for the OASAS residential programs. **ESSENTIAL DUTIES AND ... ** Utilization Review Manager ** **Job Details** **Job...discharge information to insurance companies . Initiate and resolve appeals . Work with the clinical and nursing teams… more
    Phoenix House (06/25/25)
    - Related Jobs

  • Pharmacist, Utilization Management (UM)

    Molina Healthcare (NY)
    …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
    Molina Healthcare (07/19/25)
    - Related Jobs

  • RN/Case Manager -MSH-Case…

    Mount Sinai Health System (New York, NY)
    …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years? experience as a ... **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
    Mount Sinai Health System (07/15/25)
    - Related Jobs

  • RN/Case Manager -Inpatient-Mount Sinai…

    Mount Sinai Health System (New York, NY)
    …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years? experience as a ... **Job Description** **RN/Case Manager Inpatient Mount Sinai West FT Days 8a-4p...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
    Mount Sinai Health System (07/08/25)
    - Related Jobs

  • Case Manager - Per Diem

    Stony Brook University (Stony Brook, NY)
    …skills while adhering to our high standard of excellence. **Duties of a Case Manager in the Care Management Department may include the following but are ... Case Manager - Per Diem **Position Summary** At Stony...not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity… more
    Stony Brook University (07/09/25)
    - Related Jobs

  • Manager Case Management (Registered Nurse)

    Crouse Hospital (Syracuse, NY)
    …day management of the RN Care Managers in the department , including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing ... outreach programs. Crouse's Care Coordination team is hiring a Manager who is responsible for providing day to day...day management of the RN Care Managers in the department . Pay Range: $95,000 plus based on education and… more
    Crouse Hospital (05/07/25)
    - Related Jobs

  • Case Manager - Case Management

    Arnot Health (Elmira, NY)
    …errors, types and recurring issues. 4. Facilitates, coordinates and prepares denial appeals working with internal and external customers in a proactive manner to ... bring satisfactory resolution in coordination with other department staff 5. Relays denial information to appropriate billing clerks and management. 6. Follow up on… more
    Arnot Health (05/08/25)
    - Related Jobs