- Healthfirst (NY)
- …degree + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization management/case ... and Responsibilities: + Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity,… more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal ... of clinical nursing and medical practices, the Clinical Appeals Specialist will review...will be responsible for tracking, trending and monitoring of appeals , grievances , NYS external review, and making… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal… more
- Point32Health (MA)
- …are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Training Specialist is responsible for the development, ... of the various roles within Health Care Services, including utilization management and appeals and grievances to develop workflows, job aids, and policies. This… more
- BayCare Health System (Clearwater, FL)
- …and clinical excellence. **Summary:** + Handles and processes customer appeals and grievances in accordance with established guidelines, company policies, ... and legal regulations. + Receive and document customer appeals and grievances via multiple channels (phone, email, online portals) in systems. + Ensure accurate… more
- Robert Half Accountemps (Durham, NC)
- …corporate medical policies and collaborate with Medical Directors for decisions regarding clinical appeals / grievances * Ensure quality, efficiency, and ... Description We are in search of an Intake Specialist to join our team. This role is...standards. Responsibilities: * Analyze and resolve confidential and sensitive appeals , grievances , and coverage/organization determinations from various… more
- Veterans Affairs, Veterans Health Administration (IN)
- …VA Handbooks and Directives Respond to inquiries about disciplinary actions, grievances , and appeals concerning timeliness, documentation, and other requirements ... Summary The Lead Human Resources Specialist serves as a subject matter expert in...assigns tasks, evaluate work, advises employees, handle complaints, and grievances with the oversight of the supervisor Evaluate unit… more
- Arab Community Center for Economic and Social Serv (Dearborn, MI)
- …to access services and rights processes + Assist with resolution of local complaints, grievances , and appeals processes + Survey, track, trend, and report on ... Intake & Customer Service Specialist Department: Community Health & Research Center Location:...are significant changes to the client history or other clinical issues that are presented) + Strong customer service… more
- Arab Community Center for Economic and Social Serv (Sterling Heights, MI)
- …to access services and rights processes - Assist with resolution of local complaints, grievances , and appeals processes - Survey, track, trend, and report on ... Intake and Customer Service Specialist Department: Community Health & Research Center Location:...are significant changes to the client history or other clinical issues that are presented) - Strong customer service… more
- FLACRA (Clifton Springs, NY)
- …closely with Managed Care insurance providers to understand their policies, including grievances and appeals , and assist clients with advocacy as needed. ... Utilization Management Specialist Clifton Springs, NY (Onsite) Full-Time $16.50 -...of stay criteria. + Perform preauthorization and continued stay clinical reviews for insurance companies within the required time… more
- Dignity Health (Bakersfield, CA)
- …manner to the health plan. - Partners as needed with the appeals and grievances functions of the department. **Qualifications** **Minimum Qualifications:** ... Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a… more
- LA Care Health Plan (Los Angeles, CA)
- …due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals response letters ... Authorization Technician II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID:… more
- State of Colorado (Pueblo, CO)
- …Number Psychologist SCCF 680 1/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 01/16/2025 Closing Date 1/30/2025 ... position is open to Colorado state residents only. $25,000 Hiring Incentives for Clinical Professionals for full time positions: Payout will be $5,000 after the… more
- State of Colorado (CO)
- …plans; + Diagnose and treat dental disease of offenders or refer offenders to specialist for treatment; + This position may be required to participate in restraining ... of care; + Collaborate with other health care professionals, clinical services staff regarding offender health issue/policies, transfers, classifications and… more
- State of Colorado (Limon, CO)
- …Description of Job This position will perform routine support services and clinical tasks for the incarcerated offenders in either an outpatient clinic, infirmary, ... primarily for medical reasons; + Perform all types of clinical support services necessary for the operations of a...supplies for store rooms and examination rooms; + Coordinate grievances by logging and mailing back responses. Complete flow… more
- Henry Ford Health System (Detroit, MI)
- …Operations, Compliance, FDR oversight activities, Quality Management, Care Management, and/or Grievances and Appeals . + Demonstrated experience at a professional ... and compliance risks. + Provides instruction to department staff and clinical employees in correct documentation processes and coding guidelines. + Provides… more
- Point32Health (Canton, MA)
- …met + Track stakeholder feedback on product performance throughout the year, including Appeals & Grievances to help inform future benefit design guidance, ... timelines. The Senior Manager works closely with claims, membership operations, clinical services, care management, customer relations, sales, marketing, and other… more