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Audit Manager
Jobgether
As Audit Manager, you will provide strategic and operational leadership for the nurse investigations function, ensuring high-quality clinical reviews, consistent investigative standards,…
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Case Manager, Reimbursement - Evening Shifts
United Biosource Corporation
…patients, healthcare providers and field reimbursement. The Case Manager is responsible for ensuring prior authorizations, reauthorizations and appeals are obtained in a timely manner, as…
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Audit Manager
Arizona Department of Administration
The Audit Manager will report to the Inspector General. This position is responsible for the direct oversight of the Quality Assurance Nurse Investigations Unit as a highly skilled…
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Patient Access Specialist
CareMetx
Under the general supervision of the designated manager, the Patient Access Specialist will be providing advanced services to patients, providers, and caregivers on behalf of patients for a…
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Supervisor, Clinical Denials & Appeals
ECU Health Medical Center
Coordinates and directs the daily activities of the Clinical Appeals Specialists responsible for appeals on denied claims for ECU Health System.
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Manager, Utilization Management
Centene Management Company LLC
Position Purpose: Manages Prior Authorization, Concurrent Review, Retrospective Review Clinical Review and/or Appeals team to ensure appropriate care to members. Manages utilization…
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Claims Manager
Centivo
As a Claims Manager, you will be responsible for the oversight and management of health claims processing for our self-funded employer groups. You will have direct management of claim…
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Conditional Payment Specialist (33186)
EXAMWORKS COMPLIANCE SOLUTIONS LLC
…directly determine whether we can move forward with disputes or appeals. Working closely with Medicare and its contractors, you will secure essential documentation, ensure rigorous…
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Conditional Payment Specialist (33186)
IME RESOURCES LLC
…directly determine whether we can move forward with disputes or appeals. Working closely with Medicare and its contractors, you will secure essential documentation, ensure rigorous…
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Senior Clinical/Operations Internal Monitoring Manager
Clover Health
Specifically, this role provides direct clinical monitoring leadership by conducting clinical evaluations for UM and clinical appeals to guarantee high-quality, sound clinical…
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2027 Summer Internship Program - AI Healthcare Operations
CareSource Management Services LLC
Support the development of AI-driven solutions and automation within healthcare operations, with a focus on improving prior authorization, appeals, and related business processes.
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Case Manager, Reimbursement
United Biosource Corporation
…patients, healthcare providers and field reimbursement. The Case Manager is responsible for ensuring prior authorizations, reauthorizations and appeals are obtained in a timely manner, as…
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Accounts Receivable Specialist (70799)
United Digestive
Works appeals/denials in a timely manner and creates solutions to prevent future denials.
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Director, Revenue Cycle Operations - Tempus AI Diagnostics
Tempus AI, Inc.
Recent advancements in underlying technology have finally made it possible for AI to impact clinical care in a meaningful way. Tempus' proprietary platform connects an entire ecosystem of…
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Case Manager - Utilization Management
Lehigh Valley Hospital
Provides timely, accurate, and thorough clinical reviews to assist in the patient class decision-making process.
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Client Engagement Manager - Post-Pay, Specialist
Color Employer, LLC
Serve as an expert resource across the post-payment continuum, including COB, data mining, DRG review, coding or clinical chart review, provider outreach, overpayment validation, recovery,…
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Healthcare, Release of Information Audit Abstractor
Mass General Brigham Incorporated
…but not limited to, responding to third party payer requests, appeals, denials, QIO, Mass Health, RAC, CMS, ADR, HEDIS, Medicare Risk Adjustment, CERT, CDAC, DPH reporting, DRG, charge…
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Case Manager - Utilization Review Specialist
Jobgether
…strengthening reimbursement outcomes, and ensuring compliance with clinical and payer requirements. In this remote role, you will oversee admission and concurrent utilization reviews,…
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Clinical Denial Specialist - Diagnosis Related Grouping (DRG)
SYSTEM West Virginia University Health System
…review/appeal, reporting, monitoring, and analyzing hospital based clinical, coding, and diagnosis related grouping denials. This role ensures the accuracy and integrity of billed services…
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Oncology Nurse Practitioner - Aetna Oncology Care Team
CVS Health
The Oncology Nurse Practitioner provides telephonic and virtual clinical support to members with cancer across the continuum of care. The role delivers comprehensive assessment, symptom…
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Director, Patient Services, Neuromuscular Disorders
ITF Therapeutics
Partner closely with the field-based Field Reimbursement Manager (FRM) and national accounts teams to provide personalized issue resolution, address complex appeals, and resolve localized…
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Oncology Nurse Practitioner - Aetna Oncology Care Team
Aetna Resources, LLC
The Oncology Nurse Practitioner provides telephonic and virtual clinical support to members with cancer across the continuum of care. The role delivers comprehensive assessment, symptom…
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Field Reimbursement Manager - Botox Therapeutic
AbbVie
The Field Reimbursement Manager (FRM) shares expertise and educates on Medical and Pharmacy benefits, Buy & Bill and Specialty Pharmacy acquisition, payor policy, appropriate patient…