- Mount Sinai Health System (New York, NY)
- **Job Description** **Director Pre Appeals Management -HSO Appeals Management -Corporate 42nd Street-Full-Time-Days -Remote** The Director, Pre Appeals ... Management is a strategic enterprise leader who provides strategic...related field strongly preferred + **Licensure/Certification** : + Active RN license in the state of employment required +… more
- Trinity Health (Albany, NY)
- …advanced certification or a combination of advanced training and/or certification (eg, Registered Nurse , Licensed Practical Nurse , Certified Pharmacy ... processes & procedures & ability to readily acquire new knowledge. **Data Management & Analysis:** Research & compiles information to support ad-hoc operational… more
- AnMed Health (Anderson, SC)
- …position is responsible for performing the daily operations of the Utilization Management program at AnMed within the Care Coordination model. These duties include ... necessity review, continued stay/concurrent review, retrospective review, bed status management , resource utilization management , regulatory compliance, and… more
- Mount Sinai Health System (New York, NY)
- …- Full Time - Day** The Program Manager is responsible for the daily management and oversight of the Crisis Respite, a short-term (up to 28 days) therapeutic ... supervise all professional and para-professional staff, with the exception of RN 's and Psychiatrist, and oversee the operation of the program. **Qualifications**… more
- University of Southern California (Arcadia, CA)
- …impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review/case management in an acute care ... (Required) + Graduate from a program of nursing, BSN, Health Information Management RHIT, RHIA, or foreign medical doctorate degree strongly preferred. + Accredited… more
- Hartford HealthCare (Farmington, CT)
- …now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system. ... and completeness, following regulatory requirements, in order to resolve edits, denials or exceptions detected during system processing of the claim. *_Position… more
- Bassett Healthcare (Cooperstown, NY)
- …+ 1 year leadership experience, preferred Licensure/Certifications: + Current NYS Registered Professional Nurse license, required + Current BLS certification, ... with Departmental Leadership as needed. + Participates in insurance denials on an as-needed basis. + Is a resource...or be suspended at any time. Bonus Amount: + RN (excluding management ) sign-on bonuses are awarded… more
- Ascension Health (Austin, TX)
- …**Call Schedule:** 1 in 4 call + **Practice Detail:** 1 CMA per Physician, 1 Clinical RN per location and 2 infusion RN 's at each infusion location. We also have ... an RN , BSN serving as the Clinical Staff Supervisor overseeing...diagnostic and treatment skills. Coordinates discharge planning with case management . + Recommends, participates in, and works to ensure… more
- BriteLife Recovery (Englewood, NJ)
- …+ Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials , approvals, and ... of 2-3 years of experience in utilization review, case management , or insurance coordination in a behavioral health or...a related field required; advanced degree or licensure (eg, RN , LCSW, LPC, LMHC, or CADC) preferred. + Excellent… more
- Huron Consulting Group (Chicago, IL)
- …you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, and directing implementation of the ... Utilization Review Plan and the overall operation of the Utilization Management Department in accordance with federal, state and local guidelines, regulatory… more