- Elevance Health (Waukesha, WI)
- **Behavioral Health Medical** **Director-Psychiatrist** ** Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of ... clinical operational aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss… more
- Elevance Health (Waukesha, WI)
- **Audit & Reimbursement Senior- Appeals ** **_Location:_** _This role enables associates to work virtually full-time, with the exception of required in-person training ... independently on assignments and under minimal guidance from the manager . + Prepare detailed work papers and present findings...report reopenings. + Manage caseload of Medicare cost report Appeals + Position papers + Jurisdictional Reviews + PRRB… more
- Elevance Health (Waukesha, WI)
- **Audit & Reimbursement II- Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... Perform cost report reopenings. + Under guided supervision, participate in completing appeals related work: + Position papers + Jurisdictional Reviews + Maintaining… more
- Cardinal Health (Madison, WI)
- …services. . Help patients understand insurance coverage, out-of-pocket costs, and appeals processes. . Assist in obtaining insurance, prior authorization, and appeal ... and develop effective solutions. . Provide guidance and training to junior case managers on best practices. **Communication & Collaboration** . Provide world-class… more
- Molina Healthcare (Milwaukee, WI)
- …may have technical team members. **Expanded Scope:** The Senior Project Manager for Claims Operations drives complex, multi-workstream initiatives that span people, ... Design scalable workflows and controls across intake, adjudication, adjustments, appeals /grievances, and payment integrity. + Technology Enablement: Oversee requirements,… more
- Banner Health (WI)
- …make Banner Health the best place to work and receive care. As an Associate Manager of RN Denials Management, you will be an integral part of leadership within the ... including Direct Reports; + Ideal candidate will be experienced in Denials Management, Case review, and understanding of insurance. **This can be a remote position… more
- Ralliant (Madison, WI)
- **Job Title:** Product Manager **Location:** Remote, USA **Job Summary:** As a key contributor within Hengstler-Dynapar, the **Product Manager ** will guide the ... aligns with the company's business objectives while collaborating cross-functionally. The Product Manager will work closely with all functions within our company to… more
- Sharecare (Madison, WI)
- …days of training. PTO needs during the training period will be evaluated on a case by case basis and must be approved in advance._ **Compensation:** $22.00/hour ... enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical,… more
- Molina Healthcare (Madison, WI)
- …Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
- Elevance Health (Waukesha, WI)
- …director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance to account reporting ... medical director is directly involved in Utilization Management and Case Management. + Daily case reviews for...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more