- UNC Health (Chapel Hill, NC)
- …communities we serve.RN Utilization Manager position specifically for a Utilization Manager/Clinical Appeals Nurse. This person is based at the Hedrick building and ... Enters all pertinent review data into the correct computer system in a timely manner. Consults with Physician Advisor...is a State position employed by UNC Health Care System . Qualified applicants will be considered without regard to… more
- The University of Vermont Health Network (Elizabethtown, NY)
- …of the organization. The manager is responsible for coordinating with system hospitals for admission referrals. Qualifications / Job Requirements:Education / Skills ... guidelines, and quality issues related to utilization management with application for appeals and denials management. * Knowledge of team/small group principles and… more
- ManpowerGroup (Durham, NC)
- **Title:** **Clinical Appeals Analyst** **Location: 4613 University Drive Durham NC 27707 United States (Onsite)** **Duration: 6+ months** **Pay rate: $41.75/hr (On ... W2)** **Job Description:** The Clinical Appeals Consultant is responsible for supporting the increased workload in the Claims Department, particularly due to an… more
- Martin's Point Health Care (Portland, ME)
- …Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational ... Place to Work" since 2015. Position Summary Job Description Position Summary: The Appeals Specialist (Medicare or US Family Health Plan) is responsible for ensuring… more
- Fallon Health (Worcester, MA)
- …purpose** : Responsible for the coordination and timely completion of provider appeals . Serves as a liaison between Fallon Health and contracted and non-contracted ... providers with appeals regarding filing limit appeals , claim denials,...the documented process. + Ability to review correspondence and system data to establish facts and draw valid conclusions… more
- CVS Health (Carson City, NV)
- …or audit experience. Experience in research and analysis of utilization management systems . Preferred Qualifications Knowledge of Fast Track Appeals and includes ... affordable. Position Summary Responsible for managing to resolution of Fast Track Appeals for Medicare products, which may contain multiple issues and, may require… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- CVS Health (Hartford, CT)
- …opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their ... of this Medical Director role are related to Medicare Appeals .* Direct daily work on part C appeals...more years of experience in a Health Care Delivery System eg, Clinical Practice or Health Care Industry *… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...and certain positions in the Emergency Department). Alameda Health System is an equal opportunity employer and does not… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting… more
