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Clinical Appeals & Utilization Manager
Job Description & How to Apply Below
Montefiore Medical Center is seeking an RN/PA/HIM professional to directly manage the appeals process for the Wakefield Division. The role interfaces with health plans, coordinates with Finance and Contracting on utilization management issues, and analyzes denial trends to minimize financial impact.
The position requires a strong knowledge of medical necessity, documentation, and regulatory rules. You will mentor Case Managers/CTCCs and collaborate across departments to ensure compliant appeals
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