- Elevance Health (Meridian, ID)
- **Title: Grievance & Appeals Coordinator ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles ... of one of our PulsePoint locations. The **Grievance & Appeals Coordinator ** is responsible for investigating and...and benefit coverage issues. Triages clinical and non- clinical inquiries, grievances and appeals , prepares case… more
- CVS Health (Atlanta, GA)
- …supports the daily processing of appeals in the Commercial Member Clinical Appeals (CMCA). Job functions include, completing appeals determination ... the daily processing of appeals in the Commercial Member Clinical Appeals (CMCA). Job functions include, completing appeals determination letters, intake… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …The Role Brighton Health Plan Solutions (BHPS) is seeking an experienced Appeals Coordinator skilled in investigating and resolving grievances, provider payment ... disputes and medical appeals submitted by our members and providers. Responsible for...of claims and medical documentation. + Prepare cases for clinical review. + Advanced claim processing including professional, facility… more
- Centene Corporation (Springfield, IL)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- Centene Corporation (Tallahassee, FL)
- …competitive benefits including a fresh perspective on workplace flexibility. Pharmacy Coordinator - (Grievances, Appeals , and Prior Authorizations) Remote - ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- Commonwealth Care Alliance (Boston, MA)
- …, operations, pharmacy, dental, reporting, and member services. - Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day ... **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department...strict deadlines. - When necessary collaborate with care teams, clinical staff, family members, and other involved in providing… more
- University of Utah (Salt Lake City, UT)
- …PRN40045B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals Coding Specialist SR **Job Grade** E **FLSA Code** Nonexempt **Patient ... or other specialty certification indicated by the department, AND 3 years coding, clinical , or billing experience or equivalency (one year of education can be… more
- Medical Mutual of Ohio (OH)
- …D experience is highly sought after._** **Responsibilities** **Medicare Pharmacy Coordinator I** Working under general supervision, administers standardized to ... outbound calls to members, providers, and pharmacies to initiate coverage determinations/ appeals , prescription refills, and switch members to lower cost therapeutic… more
- Providence (Beaverton, OR)
- …the best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** + Support the commercial insurance ... + This posting is for multiple openings of a Clinical Care Coordinator RN + This position...Management Experience (EX. Concurrent Review, Prior Authorization, Medical Audits, Appeals or Delegation) + Experience working in a health… more
- Providence (WA)
- …the best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Maternity / Pediatrics who will:** + Support the ... + This posting is for multiple openings of a Clinical Care Coordinator RN, Maternity / Pediatrics...Management Experience (EX. Concurrent Review, Prior Authorization, Medical Audits, Appeals or Delegation) + Experience working in a health… more
- Rush University Medical Center (Chicago, IL)
- …less than 0.5) **Shift:** **Shift 1** **Work Schedule:** 8 Hr **Summary:** The Clinical resource coordinator (CRC) applies a collaborative approach in working ... disability, veteran status, and other legally protected characteristics.** **Position** Clinical Resource Coordinator Per Diem **Location** US:IL:Chicago **Req… more
- CVS Health (Richmond, VA)
- …affordable. **Position Summary** Responsible for intake, investigation and resolution of appeals , complaints and grievances scenarios for all products, which may ... responses from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance. Identify trends and emerging issues and report… more
- State of Colorado (Denver, CO)
- Youth Corrections Medical Operations Coordinator (Nurse V) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4573875) Apply Youth Corrections ... Medical Operations Coordinator (Nurse V) Salary $108,540.00 - $151,968.00 Annually Location...clinic operations + Respond to case escalations + Provide clinical coverage as needed + Review and approve the… more
- State of Colorado (Crowley County, CO)
- …Social Worker/Counselor IV-SOTMP Mental Health Coordinator (Arkansas Valley) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4613303) Apply ... CDOC Social Worker/Counselor IV-SOTMP Mental Health Coordinator (Arkansas Valley) Salary $7,087.00 - $9,922.00 Monthly Location Crowley County, CO Job Type Full Time… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Case Management (CM) Coordinator position is a proficient CM representative that provides technical, clerical and data management support ... and other community resources and transportation. In addition, the CM Coordinator position anticipates independent actions necessary to provide competent and… more
- Omnicell (Grapevine, TX)
- …The OSPS (Omnicell Specialty Pharmacy Services) Pharmacy Audit and Credentialing Coordinator supports the OSPS PSAO through various functions, including but not ... timely manner. + Coordinate the preparation of third-party audit responses and appeals when necessary. + Facilitate the completion of audit documentation from… more
- Baptist Memorial (Memphis, TN)
- Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support billing compliance and external regulatory requirements. ... Responsibilities + Abstracts pertinent information from the medical record to create appeals for cases denied by governmental payors. + Educates department staff to… more
- Elderwood (Wheatfield, NY)
- Salary Pay: $72,150 - $87,750 / year Overview Sign on bonus for MDS Coordinator $10,000 for full-time (paid over 12 months) What makes Elderwood at Wheatfield ... We want to talk with you! RN - MDS Coordinator Position Overview: + Oversees, reviews and/or completes the...of Benefits Program + Increased Tuition Reimbursement Program for Clinical Tracks + Shift Differentials + Full Benefits Package… more
- Spaulding Rehabilitation (Charlestown, MA)
- Development Coordinator , Communications and Events - ( 3303477 ) **Description** The Development Coordinator of Communications and Events will support both the ... Programs, Events & Special Projects, respectively. For the Communications Team, the Coordinator will help plan and execute annual giving efforts and donor… more
- CareOregon (Medford, OR)
- …must comply with all federal laws. Job Title Registered Nurse - Care Coordinator (Community) Exemption Status Exempt Department Clinical Services Manager Title ... to achieve optimal health and wellness outcomes. Registered Nurse - Care Coordinator is part of an innovative multi-disciplinary care coordination team addressing… more
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