- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details 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
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: The Clinical Manager , Provider Appeals supports appeals team members to plan, direct, evaluate, coordinate, and manage the activities ... and Duals) in accordance with internal HAP policies. Coordinate with the other Appeals and Grievance department managers and other team members on provider… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department : CSC Appeals & Grievances Location: Los Angeles, ... net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances...in a manner consistent with regulatory requirements from the Department of Managed Health Care, Department of… more
- 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
- Molina Healthcare (GA)
- …Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training, leadership and mentoring for less ... request authorization. Strongly prefer candidates with a background in appeals and grievances. Excellent computer multi-tasking skills and good productivity… more
- Munson Healthcare (Traverse City, MI)
- …customer service/interpersonal skills 6. Monitors and sorts incoming communication to the Utilization Management and Appeals department , including faxes, ... verbal communication skills. ORGANIZATIONAL RELATIONSHIP . Report to the Manager of Utilization Management and works closely... Utilization Management and works closely with the Utilization Management and Appeals team . Interacts… more
- Beth Israel Lahey Health (Burlington, MA)
- …Officer as part of an integrated Revenue Cycle model. + Ensures the Utilization Review department maintains documented, up-to-date policies and procedures and ... a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for determining… more
- Children's Mercy Kansas City (Kansas City, MO)
- …review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital performance ... to integrated inpatient teams; assists Director in the management of department ; including personnel and fiscal management and development of, and training… more
- Mount Sinai Health System (New York, NY)
- …Nurse denial phone calls for UM Nurse to follow + Prioritizes work as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring it… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Manages the utilization of referral services. Enhances quality of care by assuring compliance with policies, including safety, ... **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages policies… more
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