• Manager , Denial , Appeal ,…

    Guthrie (Sayre, PA)
    Summary The Denial , Appeal , and Audit Manager is responsible for the oversight and management of all payer denials, appeals, and audit processes ... claim denials, effective appeal strategies, and proactive audit response. The manager leads a team...dashboards and reports to track denial rates, appeal success rates, and audit recoveries +… more
    Guthrie (10/03/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Warren, MI)
    …**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional ... medical claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and...to clinical experience + Documents clinical review summaries, bill audit findings and audit details in the… more
    Molina Healthcare (09/06/25)
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  • Physician Advisor

    HonorHealth (AZ)
    …with level of care and length of stay management, assists with the denial management process, reviews and makes suggestions related to resource and service ... is not available, discusses the process for issuance and appeal to the physician. Documents patient care reviews, decisions,...Care Management in a data-driven approach. Notifies the care manager of any conflict of interest in reviewing a… more
    HonorHealth (09/17/25)
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  • Authorization Technician II

    LA Care Health Plan (Los Angeles, CA)
    …collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory ... inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/ appeal requests, and prepares UM Activity and Weekly Compliance… more
    LA Care Health Plan (08/29/25)
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  • Insurance Specialist II - Corporate Patient AR…

    Guthrie (Sayre, PA)
    …Insurance Billing Specialists I and related support staff. Works closely with Director, Manager , Supervisor and Application Analyst on day to day priorities and to ... to determine specific issues and patterns that need to be addressed. Serves on Denial Task Force(s) and assists in developing action plans to reduce denials and… more
    Guthrie (09/11/25)
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