- Hartford HealthCare (Farmington, CT)
- …Key responsibilities include timely investigation of DRG downgrades, submitting appeals , coordinating follow-up actions, and ensuring compliance with regulatory ... documentation to validate or appeal payer denials. . Prepare, document, and submit appeals for DRG denials, ensuring appeals are well-supported with clinical… more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Manager Revenue Cycle position is responsible for the daily management of the staff and operations for one or more of the following areas ... to: medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross and Blue Shield of Minnesota Position Title: Care Advocacy Case Manager RN - Bilingual Spanish Location: Remote Career Area: Health Services About Blue ... across the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and tools.… more
- CBRE (Dallas, TX)
- VAS - Institutional Funds Manager Job ID 230919 Posted 02-Dec-2025 Service line Advisory Segment Role type Full-time Areas of Interest Valuations/Appraisal ... The Role:** As a CBRE VAS - Institutional Funds Manager , you will independently prepare market value appraisals on...of the property; conducting analyses and studies, eg, land utilization , supply and demand, economic feasibility, highest and best… more
- Molina Healthcare (NE)
- …to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department . We are seeking a Registered Nurse with ... modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …the Hospital through collaborating with, advising, and teaching the Care Coordination Department ; serving as a member of the medical staff; and coordinating with ... integrity, and identification of trends in the over and under- utilization of resources. 2. The Physician Advisor should be...as needed and makes suggestions to providers and appropriate department chairs as necessary * Provide consultation to Care… more
- AmeriHealth Caritas (Philadelphia, PA)
- …at www.amerihealthcaritas.com . **Responsibilities:** Under the supervision of the LTSS Manager /Director for Utilization Management, this position is responsible ... Home Modification Team and staff members within the LTSS Review Utilization Management Department . Responsibilities include providing technical and operational… more
- Sharp HealthCare (La Mesa, CA)
- …as appropriate in Cerner and Allscripts Care Management and provides information to the department head as indicated. + Utilization review and utilization ... **Facility:** Grossmont Hospital **City** La Mesa ** Department ** **Job Status** Per Diem **Shift** Day **FTE**...0 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager … more
- The County of Los Angeles (Los Angeles, CA)
- …an assistant to the manager of a line operation in a County department . Experience at the level of the Los Angeles County's Class of Administrative Assistant Iis ... making recommendations to line managers on matters such as: utilization of personnel; allocation of funds; workload and workload...manager of a line operation in a County department . Experience at the level of the Los Angeles… more
- State of Colorado (Pueblo, CO)
- …not rise to a reportable occurrence, this position makes recommendations to the Occurrence Manager for referral to a CMHHIP department or specific discipline ... and tied to CMHHIP's improvement goals. + Participate in utilization management and review activities when requested, applying clinical...of various processes in collaboration with the assigned Nurse Manager or Department Leader. + The audits… more