- 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 ... complaints, appeals and grievance cases for products for...case reviews, and prepares final case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy… 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 ... must reside in Florida Equal Opportunity Employer Veterans/Disabled **Position** Intake Specialist Appeal and Grievance - Health Plan **Location**… 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 ... and grievance process that meets state, federal, accreditation and other...of clinical nursing and medical practices, the Clinical Appeals Specialist will review… more
- Kelsey-Seybold Clinic (Houston, TX)
- …determined within appropriate timeframes. This position will serve as a liaison to the Grievance and Appeals Department for Medicare Advantage appeals . The ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews,...plan, ACO, IPA, or provider group or 3 years clinical nursing experience Preferred: N/A **License(s)** Required: TX LVN… more
- Elevance Health (Costa Mesa, CA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... shifts between 7am - 7pm CT (later shift hours preferred) The ** Clinical Operations Associate Medical Director** is responsible for supporting the medical management… more
- LA Care Health Plan (Los Angeles, CA)
- …track all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals ... 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 (CO)
- …Job Number CAA Physician 01/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 12/18/2024 Closing Date 6/30/2025 4:00 ... on-call assessment, diagnosis, and treatment of inmates in one or more prison clinical settings. Physicians are responsible for, but not limited to, the following: +… more