- Alameda Health System (San Leandro, CA)
- SLH Case Manager RN + San Leandro, CA + San Leandro Hospital + SLH Social Services + Part Time - Day + Care Management + $58.74 - $97.91 per hour + Req #:42605-31625 ... + FTE:0.7 + Posted:August 6, 2025 **Summary** **JOB SUMMARY** The SLH Case Manager RN is responsible for providing comprehensive case management services to clients… more
- McLaren Health Care (Grand Blanc, MI)
- …of Medicine Degree **.** **4 years of utilization management, case management, clinical documentation, and/or denials/ appeals experience in an acute healthcare ... trends and direction to assist front-end processes such as utilization management, clinical documentation improvement, coding, and billing etc. to reduce denials. 4.… more
- CareFirst (Baltimore, MD)
- …authorization of services and approved claims. + Prepares retrospective reviews, case appeals , billing coordination, and clinical support. + Manages the analysis ... hiring methods to meet departmental needs. We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who is willing and able… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of ... In this role, you will be responsible for evaluating and responding to clinical and administrative denials referred to Case Management Department for appeal. You… more
- Iowa Department of Administrative Services (State Of Iowa, IA)
- …IA Job Type Full-time Job Number 26-00884 Agency 427 Department of Inspections, Appeals & Licensing Opening Date 10/02/2025 Closing Date 10/12/2025 11:59 PM Central ... a sense of purpose? The Iowa Department of Inspections, Appeals , and Licensing (DIAL) is seeking a highly motivated,...you will work under the supervision of the Unit Manager while traveling state-wide on a weekly basis to… more
- State of Colorado (Denver, CO)
- …venipuncture and other related laboratory tests; + Follow the CDOC clinical services standards and procedures, protocols, guidelines, or policies pertaining to ... medical practice and treatment as specified by Clinical Services administration; + May provide initial emergency medical...must possess current, valid licensure as an Advanced Practice Nurse / Nurse Practitioner from the Colorado… more
- Elevance Health (Morristown, NJ)
- ** Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management** **Virtual** : This role enables associates to work virtually ... Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology._ The ** Clinical … more
- State of Colorado (Pueblo, CO)
- …+ Participates in the QA/PI process at the unit level as directed by the Nurse Manager + Attends weekly nursing rounds or read/review and understand information ... Reports ALL claims of harassment/workplace violence, alerts public safety/charge RN/ Nurse Manager /and nursing appointing authority immediately Communication/… more
- State of Colorado (Pueblo, CO)
- …CAA P/T 3557 Physician 5/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 05/12/2025 Closing Date 10/16/2025 4:00 ... on-call assessment, diagnosis, and treatment of inmates in one or more prison clinical settings. Physicians are responsible for, but not limited to, the following: +… more
- Molina Healthcare (San Bernardino, CA)
- …medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse ... and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical … more