• Clinical Denial Appeals Specialist

    TEKsystems (Annapolis, MD)
    …utilization review (or utilization management or healthcare management), certified case manager , certified documentation specialist, certified coder, certified ... Description Position Summary The clinical denial appeals specialist is responsible for the identification, mitigation, and prevention of clinical denials. This staff… more
    TEKsystems (08/26/25)
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  • Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is...assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and cohesive unit with… more
    LA Care Health Plan (08/29/25)
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  • Complaint & Appeals Analyst (Must reside…

    CVS Health (Phoenix, AZ)
    …activity as well as preparing for appeals audits. + Consults with manager on complex cases and interfaces with case managers, clinical supervisors, and ... + Assigns reviews to Medical Directors and enters all data related to appeals and case reviews into a database. + Participates in data and analysis of reports… more
    CVS Health (08/22/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Omaha, NE)
    …unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance… more
    Molina Healthcare (08/20/25)
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  • RAC Case Manager

    OhioHealth (Columbus, OH)
    …This position assists in development, implementation, refinement and reporting of the RAC case management and appeals program. It is accountable for reviewing ... to achieve timely, cost efficient and effective management of the RAC case management appeals process. **Responsibilities And Duties:** 80% Identifies… more
    OhioHealth (08/29/25)
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  • CDOC - Corrections Case Manager

    State of Colorado (Canon City, CO)
    CDOC - Corrections Case Manager I (CTCF) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5057391) Apply  CDOC - Corrections Case ... re-entry into society. Primary job duties and responsibilities for Case Manager I positions include, but are...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
    State of Colorado (08/27/25)
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  • RN/ Case Manager -MSH- Case

    Mount Sinai Health System (New York, NY)
    **Job Description** **RN/ Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management ... term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager or...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as… more
    Mount Sinai Health System (08/28/25)
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  • CDOC - Parole Release Case Manager

    State of Colorado (Canon City, CO)
    CDOC - Parole Release Case Manager (South Centennial) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5053519) Apply  CDOC - Parole Release ... Case Manager (South Centennial) Salary $5,546.00 -...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
    State of Colorado (08/26/25)
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  • RN/ Case Manager -Inpatient-Mount…

    Mount Sinai Health System (New York, NY)
    **Job Description** RN/ Case Manager Mount Sinai West FT Days 8a-4p EOW The Case Manager (CM) will be responsible for all aspects of case management ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information to the payor, as… more
    Mount Sinai Health System (08/16/25)
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  • RN Case Manager : University…

    University of Michigan (Ann Arbor, MI)
    RN CASE MANAGER : University Hospital (Care Management) Apply Now **Job Summary** The RN Case Manager assesses, develops, implements, coordinates and ... effective utilization of resources while promoting quality outcomes. **Organizational Relationships** The RN Case Manager reports directly to the Manager of… more
    University of Michigan (08/20/25)
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