- Catholic Health Services (Melville, NY)
- …named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... and/or escalates denial when appropriate. Submits all (initial and/or appeals ) reviews and/or letters within contractual or regulatory timeframes. Collaborates… more
- Guardian Life (Albany, NY)
- Guardian is seeking individuals with Group Disability claims experience to join our dynamic Appeals Team. The Appeals Case Manager II (ACM 2) is responsible ... share insights and learnings with claims colleagues. **Reporting Relationships:** As our Appeals Case Manager II, you will report to our Leader, Appeals … more
- CareFirst (Baltimore, MD)
- …with dynamic goals resulting in the full and fair review of appeals and grievances designed to achieve corporate objectives and advance departmental capabilities. ... and accreditation requirements. Ensures appropriate and complete resolution of appeals , Regulatory complaints and External review requests. Performs analytics and… more
- Catholic Health Services (Melville, NY)
- …services and coordinates utilization/ appeals management review. | Assist Utilization and Appeals Manager in setting up communications with payors and/ or ... facility departments. | Develops/validates daily work lists for Utilization and Appeals Manager . | Assist with all insurance and regulatory audits and provides… more
- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals (RN)to lead the daily operations of our ... to, Provider Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances. + Ensures… more
- Penn Medicine (Philadelphia, PA)
- …Experience:** + Bachelors degree in Nursing and 5+ years Working as a RN Case Manager and /or Appeals Coordinator required. We believe that the best care for ... you living your life's work? **Summary:** + The Clinical Appeals Coordinator will play an essential role in maximizing...in this important departmental process. They will oversee the appeals and denial process from beginning to end.The Coordinator… more
- Mount Sinai Health System (New York, NY)
- …issues in an accurate and timely fashion. In collaboration with the Underpayment Team manager , the Senior CBO Appeals Analyst will work to further the CBO's ... **Job Description** The Senior CBO Appeals Analyst position requires an in-depth knowledge of...hospital/healthcare environment is required. Advanced knowledge of Epic, Contract Manager , and Microsoft Excel Working knowledge of other Microsoft… more
- Fallon Health (Worcester, MA)
- …information, visit fallonhealth.org. **Brief Summary of Purpose:** Fallon Health's (FH) Appeals and Grievance process is an essential function to FH's compliance ... other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH … more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH … more
- Elevance Health (Tampa, FL)
- **Grievance/ Appeals Analyst Lead** **Candidates must be located within 50 miles an Elevance Health PulsePoint office. This position is primarily work from home but ... to work in the office quarterly.** **Schedule: Monday-Friday 8am-5pm EST** The **Grievance/ Appeals Analyst Lead** is responsible for leading and coaching a team of… more
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