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Clinical Accreditation Reviewer
URAC

Nationwide,

Prime Healthcare Logo
Director, Case Management - Utilization Management
Prime Healthcare

Inglewood, California

Case Manager
Monadnock Family Services

Keene, New Hampshire

AdventHealth Logo
Case Management Director
AdventHealth

Hendersonville, North Carolina

NEW!
WMCHealth Logo
Ambulatory Care Manager
WMCHealth

West Nyack, New York

NEW!
Vanderbilt Health Logo
Patient Care Manager Endoscopy-Inpt
Vanderbilt Health

Nashville, Tennessee

NEW!
Harris Health System Logo
Care Manager Clinical Denials
Harris Health System

Houston, Texas

NEW!
WakeMed Health & Hospitals Logo
Case Manager/Social Worker, MSW - Patient Case Management
WakeMed Health & Hospitals

Raleigh, North Carolina

NEW!
University of Maryland Medical System Logo
Manager, Case Management
University of Maryland Medical System

Baltimore, Maryland

NEW!
Cedars Sinai Logo
RN Supervisor, Case Management - Inpatient Specialty Programs
Cedars Sinai

Beverly Hills, California

NEW!
PIH Health Logo
Case Manager, Registered Nurse (RN), or License Vocational Nurse (LVN) Per diem, days
PIH Health

Downey, California

NEW!
Cedars Sinai Logo
RN Case Manager - Medical Network Care Transitions
Cedars Sinai

Los Angeles, California

NEW!
AdventHealth Logo
Care Management Assistant
AdventHealth

Zephyrhills, Florida

NEW!
UCLA Logo
RN Care Manager - Ambulatory Care Management, Hybrid-Remote
UCLA

Los Angeles, California

NEW!
Penn State Health Logo
Social Worker Outpatient II - Care Management
Penn State Health

Hershey, Pennsylvania

NEW!
AdventHealth Logo
Social Worker Care Manager
AdventHealth

Ocala, Florida

NEW!
Benefis Health System Logo
Community Care Nurse Case Manager
Benefis Health System

Kalispell, Montana

NEW!
CHRISTUS Health Logo
Emergency Department Care Manager-Case Management
CHRISTUS Health

San Antonio, Texas

NEW!
CHRISTUS Health Logo
Case Manager / Case Management / Part-time
CHRISTUS Health

Santa Fe, New Mexico

NEW!
University of Maryland Medical System Logo
RN Case Manager, Weekends
University of Maryland Medical System

Baltimore, Maryland

NEW!
AdventHealth Logo
RN Care Manager PRN
AdventHealth

Hinsdale, Illinois

NEW!
UCLA Logo
RN Case Manager, Per Diem
UCLA

Los Angeles, California

NEW!
AdventHealth Logo
Pediatric and Women's Registered Nurse RN Care Manager
AdventHealth

Orlando, Florida

NEW!
CHRISTUS Health Logo
Care Manager II - Case Management
CHRISTUS Health

Corpus Christi, Texas

NEW!
Nicklaus Children’s Health System Logo
Care Management RN (Full Time, Mid shift)
Nicklaus Children’s Health System

Miami, Florida

NEW!
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Care Manager Clinical Denials
JOB SUMMARY: The Care Manager Clinical Denials (CM-CD) is responsible for the management of clinical audits and denials related to inpatient medical necessity and/or level of care, and coding. The CM-CD reviews patient medical records and all other pertinent patient information, and applies clinical and regulatory knowledge, screening criteria and judgment, as well as knowledge of payor requirements and denial reason codes/rationale, to determine why cases are denied and whether an appeal is required. For all inappropriate denials, relevant information is submitted, according to each payor's appeal timeframes, through denial management tracking software with bi-directional interface with physician advisor appeal coordinat


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