- Catholic Health Services (Melville, NY)
- …for services and coordinates utilization / appeals management review. + Assist Utilization and Appeals Manager in setting up communications with payors ... advisors and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with all insurance and regulatory… more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The Manager , Denials Prevention & Appeals Operations is responsible for the direct oversight of daily operations of clinical denial ... position will work closely with the Denials Prevention & Appeals Administration Manager to guide the development...the Physician Advisors or attending physicians to support concurrent appeals . * Monitor and analyze utilization data… more
- CareFirst (Baltimore, MD)
- …educational and training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in the development and ... + Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used… more
- CareFirst (Baltimore, MD)
- …+ Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation...Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred + LNCC - Legal Nurse… more
- Catholic Health (Buffalo, NY)
- …role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the people, carrying out and documenting ... the appeals process for denied claims denied due to reasons...payers) and internal stakeholders including, but not limited to, Utilization Review, Case Management, Clinical Documentation Integrity, Health Information… more
- Beth Israel Lahey Health (Charlestown, MA)
- …difference in people's lives.** This is a remote based role. Reporting to the Manager , Patient Financial Services, the Clinical Analyst plays an important role in a ... high-profile team tasked with handling all commercial and government clinical appeals and audit processes. The Clinical Analyst will perform high-level clinical… more
- Elevance Health (Los Angeles, CA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... **Behavioral Health Medical** **Director-Psychiatrist** ** Appeals ** **Location:** This role enables associates to work...Director Associates. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you...strategy in response to reimbursement denials. + Responsible for appeals and follow up on clinical denials escalated through… more
- Children's Mercy Kansas City (Kansas City, MO)
- …and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing ... functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital performance improvement… more
- Mount Sinai Health System (New York, NY)
- …as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...+ Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements… more
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