- HCA Healthcare (Plano, TX)
- …is recognized. Submit your application for the opportunity below:Registered Nurse Case Manager IP RehabMedical City Plano **Benefits** Medical City Plano offers a ... by location._** We are seeking a(an) Registered Nurse Case Manager IP Rehab for our team to ensure that...Accurate and timely data collection . Promotes effective resource utilization and appropriate levels of care . Cross train… more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Manager Revenue Cycle position is responsible for the daily management of the staff and operations for one or more of the following areas ... to: medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This… more
- Sanofi Group (San Francisco, CA)
- **Job title:** Field Reimbursement Manager , Pulmonology and Gastroenterology, San Francisco **Location:** San Francisco, CA / Sacramento, CA / Remote, US _In this ... on millions of patients around the world. **Position Summary:** The Field Reimbursement Manager (FRM) will be the field subject matter expert relating to patient… more
- Warren Equipment Company (Oklahoma City, OK)
- **Description** TEAM UP WITH US! The Senior Facilities Manager oversees and manages all aspects of facility operations across multiple dealership sites, ensuring ... the facility infrastructure capital plan. . Inspect facilities and evaluate space utilization across multiple sites to ensure efficient use and alignment with… more
- Molina Healthcare (Las Vegas, NV)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure ... most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …(IROs) for timely and accurate decisions + Ensure strict adherence to Appeals and Utilization Management (UM) processes and regulatory and accreditation ... environment. The position reports directly to the Clinical Appeal Manager . Note: This job description is not intended to...including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals , Utilization Review, and Grievance processes including… more
- Sharp HealthCare (San Diego, CA)
- …policy as needed. + Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager to identify trends ... and oversees the health care needs of the membership. Serves as a medical manager and policy advisor to SHP and its Chief Medical Officer. Is accountable for… more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- …level, and alternative resources. Assists in obtaining insurance approvals/denials and/or appeals for therapy. Assists patients and HCP with processing applications ... in a combination of home care management, case management review, utilization review, social service support, insurance reimbursement, and patient advocacy,… more
- Arnot Health (Elmira, NY)
- …errors, types and recurring issues. 4. Facilitates, coordinates and prepares denial appeals working with internal and external customers in a proactive manner to ... in nursing preferred. Must have proficient writing skills.Experience in Utilization Review and InterQual required. CARDIOPULMONARY RESUSCITATION (CPR) REQUIREMENTS:… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …clinical documentation integrity, and identification of trends in the over and under- utilization of resources. 2. The Physician Advisor should be a key member ... take on the role as leader of the Hospital's utilization review/management committee, which is charged with adhering to...resources to achieve optimal outcomes * Notify the case manager of any conflict of interest in reviewing a… more
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