• Coding Spec-Clinic

    Covenant Health Inc. (Knoxville, TN)
    …and training for the coding staff. Working directly with the physicians, Manager of Corporate Coding Services, Director of Registration/Admitting, and medical staff ... resolve issues related to claims, coding, pre-cert, and denials appeals , and verifies that appropriate chargemaster rates are used....of coding staff in the areas of coding, documentation, case mix, and denials. + Increases understanding of APCs,… more
    Covenant Health Inc. (08/04/25)
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  • Data System Administrator (Salesforce) - Data…

    State of Colorado (Denver, CO)
    …APS Data system (CAPS), where caseworkers in all counties document all case records and other program operations. The CCU provides pre-employment background ... coordination with the standards set by the APS training manager for APS certification. The APS unit must be...system to efficiently collect all information related to the case and provide output of that data through reports.… more
    State of Colorado (07/22/25)
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  • Payroll Supervisor - Accountant II

    State of Colorado (Denver, CO)
    …retirement, and (g) function as back up for the Department Payroll/Timekeeping Manager and Kronos Administrator in their absence. Summary of Duties: Review and ... If an overpayment is deemed to be uncollectible, refers the case to the Payroll Accountant. + Determines compliance/noncompliance of payroll/timekeeping practices… more
    State of Colorado (07/03/25)
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  • Data Management III - Data Automation Coordinator

    State of Colorado (Denver, CO)
    …to six candidates, will be invited to schedule an interview with the hiring manager . Appeal Rights: If you receive notice that you have been eliminated from ... Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel...mean automatic disqualification and will be assessed on a case -by- case basis. As a condition of employment,… more
    State of Colorado (08/02/25)
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  • Registered Nurse (RN) - Utilization Management

    Rochester Regional Health (Rochester, NY)
    …potential inpatient medical necessity denials. Review patient class in the event manager , assist with LOC determination retrospectively, and changes patient class as ... UM review findings, initiate and 1st, 2nd, and/or arbitration appeals as needed. Document in all areas that an...REQUIRED QUALIFICATIONS: + 3 years of acute hospital care, Case Management and/or Utilization Management experience + Excellent oral… more
    Rochester Regional Health (08/02/25)
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  • CDOC Mid-Level Provider/(NP/PA) - Gender Affirming…

    State of Colorado (Denver, CO)
    …and the first 12 months of maintenance, + Follow-up hormone treatment on a case by case basis, post-operative assessment and care, and referrals to outside ... establish an eligible list for referral to the hiring manager for final consideration. Use of artificial intelligence (AI)...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
    State of Colorado (07/31/25)
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  • Registered Nurse Health Compliance Inspector Home…

    State of Colorado (Denver, CO)
    …and applying statutes, regulations, guidelines, policies and procedures on a case -by- case , item-by-item basis for facility compliance/violation. + Works as ... Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel...be invited to schedule an interview with the hiring manager . E-Verify: CDPHE uses e-Verify, an Internet-based system, to… more
    State of Colorado (07/25/25)
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  • UR Clinical Specialist

    Community Health Systems (Franklin, TN)
    …- Registered Nurse - State Licensure and/or Compact State Licensure required + CCM - Certified Case Manager preferred or + Accredited Case Manager (ACM) ... role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient… more
    Community Health Systems (07/29/25)
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  • Utilization Review Intake RN Behavioral Health

    AdventHealth (Glendale Heights, IL)
    …to prioritize multiple tasks and role components. + Registered Nurse (RN) Required + Accredited Case Manager (ACM) / Certified Case Manager (CCM) ... all members of the multidisciplinary team to facilitate care for designated case load; monitors the patient's progress, intervening as necessary and appropriate to… more
    AdventHealth (06/13/25)
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  • Care Transitions Jobs

    Beth Israel Lahey Health (Plymouth, MA)
    …strategies * Integrate clinical and reimbursement knowledge for optimal outcomes **RN Case Manager - Emergency Department UR & Discharge Planning** This ... for level of care and continued stay * Lead appeals of clinical denials and collaborate with physician advisors...Proficiency in InterQual required + CCM, ACM, or other case management certification preferred or in progress ** Manager… more
    Beth Israel Lahey Health (07/03/25)
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