- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews ... from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… more
- Catholic Health Services (Melville, NY)
- …for services and coordinates utilization / appeals management review. | Assist Utilization and Appeals Manager in setting up communications with payors ... Managers, physician advisors and facility departments. | Develops/validates daily work lists for Utilization and Appeals Manager . | Assist with all insurance… 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 ... management of clinical appeals review processes within Appeals & Grievances Department . + Manages the...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… more
- CareFirst (Baltimore, MD)
- …+ Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used ... contribution programs/plans (all benefits/incentives are subject to eligibility requirements). ** Department ** MD Medicaid and DSNP Appeals **Equal Employment… more
- Catholic Health Initiatives (Houston, TX)
- …processes appeals and reconsiderations. Act as a working manager within Utilization Management, performing essential duties and responsibilities ... **Responsibilities** The Utilization Management (UM) Manager is responsible...decision-making and promote continuous improvement. 11. Ensure that the utilization management department complies with all relevant… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... concurrent and extended stay reviews. + Prepares and submits appeals to third party payors. + Maintains appropriate records...third party payors. + Maintains appropriate records of the Utilization Review Department . + Performs related duties,… more
- University of Utah Health (Salt Lake City, UT)
- …advancement, and overall patient outcomes. **Responsibilities** + Applies approved utilization criteria to monitor appropriateness of admissions with associated ... or third-party payer. + Alerts and discusses with physician/provider and case manager /discharge planner when patient no longer meets medical necessity criteria for… more
- Molina Healthcare (Cleveland, OH)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Ochsner Health (Lafayette, LA)
- …the daily operations of all assigned divisions within the case management department in collaboration with the case management and social services leadership. ... systems (CMS) regulations, compliance and quality metrics. Experience managing denials and appeals of all payer cases in a timely and organized manner. Preferred… more
- AmeriHealth Caritas (Newtown Square, PA)
- …provides organizational leadership in the operational areas of care management, utilization review, appeals , quality improvement and related policy and ... practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The following… more
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