• Physician Advisor Denials Management

    CommonSpirit Health (Englewood, CO)
    **Responsibilities** **Thi** **s is a remote position** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews referred by case ... management staff and/or other health care professionals to meet regulatory requirements and in accordance...and health information personnel. + Conducts peer-to-peer reviews with payer medical directors to discuss and advocate for the… more
    CommonSpirit Health (07/11/25)
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  • Strategic Advisor , Healthcare

    BlueCross BlueShield of North Carolina (NC)
    **Job Description** The Strategic Advisor , Healthcare plays a crucial role in assisting with complex analysis, evaluation, and planning to achieve the organization's ... includes new forms of healthcare reimbursement, healthcare redesign consultation, payer /provider engagement, and market offer opportunities. Underwriting experience is… more
    BlueCross BlueShield of North Carolina (08/28/25)
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  • Physician Advisor

    CommonSpirit Health Mountain Region (Salt Lake City, UT)
    …roles, preferred. + Experience as a Physician Advisor in the acute care setting and/or the payer environment, preferred. + Education and experience in ... and Kansas, we deliver the same high standard of care to our employees as we do to our...position is a hybrid role requiring a mix of remote and on-site work at the five CommonSpirit Hospitals… more
    CommonSpirit Health Mountain Region (07/29/25)
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  • RN System Director Utilization Management…

    Tufts Medicine (Burlington, MA)
    …require additional hours on weekends/off hours as needed. **Location:** Primarily remote . May require occasional travel to local facilities including Tufts Medical ... of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. The health system is the… more
    Tufts Medicine (08/29/25)
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  • Clinical Denials & Appeals Specialist…

    Northwell Health (Melville, NY)
    …Serves as liaison between the patient and facility/physician and the third party payer . Prepares and defends level of care and medical necessity for ... assigned case. Collaborates with physician advisor , payor representative and site case managers to facilitate...and site case managers to facilitate appropriate level of care decisions and billing status and ensures compliance with… more
    Northwell Health (08/20/25)
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  • Clinical Review Nurse Care Manager

    Children's Mercy Kansas City (Kansas City, MO)
    …continued patient stays with Attending Physician, Physician Advisor , Inpatient Nurse Care Manager, and insurance/ payer . + Collaborates with Revenue Cycle to ... the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance knowledge, business… more
    Children's Mercy Kansas City (08/08/25)
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  • Clinical Documentation Specialist Auditor-…

    UNC Health Care (Chapel Hill, NC)
    …conditions, patient safety indicators, hierarchical condition categories and complexity of care rendered to all patients. Educates on proper creation of provider ... CPT codes in accordance with the Official Coding Guidelines, and third party payer , state and federal regulations. 10. Identifies cases for CDI Physician Advisor more
    UNC Health Care (07/29/25)
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  • RN Case Manager: ( Care Management- D. Dan…

    University of Michigan (Ann Arbor, MI)
    RN CASE MANAGER: ( Care Management- D. Dan and Betty Kahn Health Care Pavilion ) Apply Now **Job Summary** The RN Case Manager assesses, develops, implements, ... coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician,...admission; review every 3 days or as requested by payer + Determine patient classification with provider and ensure… more
    University of Michigan (08/25/25)
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  • Regional VP, Health Services Pacific Southwest…

    Humana (Sacramento, CA)
    …Partner with national innovation teams to pilot and scale emerging technologies and care models (eg, remote monitoring, clinical pathways, tech-enabled care ... and cross-functional collaboration. The RVP acts as a key advisor , innovator, and relationship builder, ensuring alignment with Humana's...years clinical practice + 5 + years in managed care industry, either provider or payer . +… more
    Humana (08/08/25)
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  • Utilization Management RN

    AdventHealth (Orlando, FL)
    …All while understanding that **together** we are even better. **Schedule:** Full Time Remote , Applicant must live within a 50-mile radius or be a current employee ... legitimacy of hospital admission, treatment, and appropriate level of care . The UM RN leverages the algorithmic logic of...UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review as determined… more
    AdventHealth (08/28/25)
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