• Appeals Case Manager II

    Guardian Life (Albany, NY)
    …with Group Disability claims experience to join our dynamic Appeals Team. The Appeals Case Manager II (ACM 2) is responsible for adjudicating assigned ... Readily share insights and learnings with claims colleagues. **Reporting Relationships:** As our Appeals Case Manager II, you will report to our Leader, … more
    Guardian Life (05/02/25)
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  • Clinical Appeals Coordinator - Pennsylvania…

    Penn Medicine (Philadelphia, PA)
    …or Equivalent Experience:** + Bachelors degree in Nursing and 5+ years Working as a RN Case Manager and /or Appeals Coordinator required. We believe that the ... you living your life's work? **Summary:** + The Clinical Appeals Coordinator will play an essential role in maximizing...will provide oversight to the process and assist the Case Managers' at PAH in this important departmental process.… more
    Penn Medicine (04/29/25)
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  • Manager , Grievance and Appeals , RN

    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
    VNS Health (03/05/25)
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  • Clinical Appeals Manager (Hybrid)

    CareFirst (Baltimore, MD)
    …- State Licensure And/or Compact State Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred or + LNCC - Legal Nurse Consultant ... goals resulting in the full and fair review of appeals and grievances designed to achieve corporate objectives and...Science Nursing or related field, Legal Nurse Consultant, Certified Case Manager . **Knowledge, Skills and Abilities (KSAs)**… more
    CareFirst (05/04/25)
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  • Member Appeals and Grievance Intake…

    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
    Fallon Health (04/15/25)
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  • Centralized Appeals Unit - Supervisor

    Louisiana Department of State Civil Service (Baton Rouge, LA)
    Centralized Appeals Unit - Supervisor Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4881433)  Centralized Appeals Unit - Supervisor ... + Description + Benefits Supplemental Information Please click HERE (https://ulsuno.wd1.myworkdayjobs.com/en-US/UniversityOfNewOrleans/job/Baton-Rouge-La/Centralized- Appeals -Unit Supervisor\_R-001713?q=R-001713) to apply + Manage and report on… more
    Louisiana Department of State Civil Service (03/25/25)
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  • Registered Nurse Clinical Denials & Appeals

    Catholic Health (Buffalo, NY)
    …Specialist, Certified Coder (CPC/CCS), Certified Processional Medical Auditor (CPMA), Certified Case Manager (CCM) or any other certification approved by ... position is accountable for carrying out and documenting the appeals process for denied claims denied due to reasons...active nursing experience in acute care setting, coding, and/or case management + Three (3 ) years of experience… more
    Catholic Health (04/23/25)
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  • RN/ Case Manager -MSH- Case

    Mount Sinai Health System (New York, NY)
    **Job Description** **RN/ Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as… more
    Mount Sinai Health System (04/15/25)
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  • Staff Nurse- Case Manager - Mount…

    Mount Sinai Health System (New York, NY)
    **Job Description** The Case Manager is responsible for all aspects of case management/ utilization review for an assigned group of inpatients, ED patients ... and identify the expected length of stay (ELOS). The case manager works collaboratively with physicians, social...with physicians and managed care companies on concurrent denial appeals * Communicates clinical information to the payor, as… more
    Mount Sinai Health System (04/16/25)
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  • Case Manager RN- Mount Sinai West-…

    Mount Sinai Health System (New York, NY)
    **Job Description** The Case Manager (CM) will be responsible for all aspects of case management for an assigned group of inpatients to determine the ... care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ...with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information to the payor, as… more
    Mount Sinai Health System (04/22/25)
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