• System Director Claim Denials

    SSM Health (MO)
    …or Medical Group revenue cycle areas. The scope of responsibility is all post-billed denials (inclusive of clinical denials ). Engages with key leadership ... improvement. + Oversees communication and follow-up processes related to denials and appeals to ensure such activities are submitted timely, tracked, trended… more
    SSM Health (08/01/25)
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  • RN Clinical Review Appeals

    St. Luke's University Health Network (Allentown, PA)
    …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... needed for workflow or identification of trends. Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and… more
    St. Luke's University Health Network (07/08/25)
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  • Appeals Manager

    BronxCare Health System (Bronx, NY)
    …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... for the staff on identified deficiencies to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely… more
    BronxCare Health System (06/21/25)
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  • Medical Director Physician Advisor UM

    AdventHealth (Altamonte Springs, FL)
    …and grievances from patients; assists in drafting and submitting clinical denial appeals , as needed + Develops Medical Director relationships with payors to ... as collaborating with other disciplines to assist in the improvement of clinical documentation, patient safety, and quality outcomes. Through primary support of… more
    AdventHealth (08/01/25)
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  • Director Case Management

    Brockton Hospital (Brockton, MA)
    …external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the ... PURPOSE OF POSITION: The Director of Case Management is responsible for planning,...the development and supervision of staff (RNs, LPN's,SWs and non- clinical support), evaluation and maintenance of case management skills… more
    Brockton Hospital (06/13/25)
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  • Director Med Staff Services

    HCA Healthcare (Manchester, NH)
    …new medical staff members (in partnership with other key stakeholders to include Director of Advanced Clinical and IT&S personnel). Facilitate orientation for ... We care like family! Jump-start your career as a Director Medical Staff Services today with Catholic Medical Center....play a key role in the integration of HCA Clinical Strategies and HCA systems. **Medical Staff Administration** Develop… more
    HCA Healthcare (06/28/25)
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  • Associate Director - Field Reimbursement…

    Bayer (Boston, MA)
    …and Managed Plans; + Experience in educating and supporting Prior Authorization process, appeals , and denials ; + Covermymeds - portal access experience a plus; ... diverse minds to make a real difference, there's only one choice.** **Associate Director - Field Reimbursement - Oncology - (Northeast USA)** **Associate Director more
    Bayer (06/07/25)
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  • Mgr CDI Quality & Educ / HIM Clinical

    Hartford HealthCare (Farmington, CT)
    …(HIM) Clinical Documentation Integrity (CDI) quality, audit, education, and denials prevention program consistent with clinical , regulatory, contractual, and ... (HACs), and other specialty reviews. This position also supports denials and appeals specialists as a subject...*_Working Relationship:_* . *This Job Reports To (Job Title):*HHC Director of Clinical Documentation Integrity** . *Job… more
    Hartford HealthCare (07/10/25)
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  • Director of Care Management - Mount Sinai…

    Mount Sinai Health System (Long Island City, NY)
    …collection, data received from external agencies, Physician 9.Advisors and the Medical Director . 10.Ensures Discharge Appeals functions are carried out within ... **Job Description** The Director will direct and manage departmental activities involved...direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate the case… more
    Mount Sinai Health System (07/24/25)
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  • Regional Medical Director , Care Management…

    UPMC (Pittsburgh, PA)
    The Regional Medical Director , CC/DP and Utilization Review, provides clinical and management leadership across multiple hospitals within the region. This role ... and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice President of Care...denials . + Direct UM functions, collaborating with CC/DP, clinical teams, and attending physicians to optimize care delivery… more
    UPMC (07/11/25)
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