- 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
- LA Care Health Plan (Los Angeles, CA)
- …required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory timelines by ... obtaining clarification on initial responses. (25%) Under the supervision of the Appeals and Grievance Manager , assist with soliciting non-clinical information… more
- 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
- 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
- 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
- Elevance Health (Walnut Creek, CA)
- **Behavioral Health Medical Director-Psychiatrist Appeals ** **Location:** California. 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
- 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
- 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
- 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
- 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