- CareFirst (Baltimore, MD)
- …programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Appeals and Analysis **Equal Employment Opportunity** ... all lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State...who is willing and able to work in a hybrid model. The incumbent will be expected to work… more
- Elevance Health (Hanover, MD)
- …contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and clinical services, ... **Location: Open to any location but must meet the hybrid workplace model requirement.** Elevance Health supports a hybrid workplace model (virtual and office)… more
- Elevance Health (Woodlawn, MD)
- …appropriateness of care and accurate claims payment. + May also manage appeals for services denied. + Conducts precertification, continued stay review, care ... policy, and member eligibility, benefits, and contracts. + Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality,… more
- Elevance Health (Woodlawn, MD)
- …appropriateness of care and accurate claims payment. + May also manage appeals for services denied. + Conducts pre-certification, continued stay review, care ... in a cost effective setting according to contract. + Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost… more
- Elevance Health (Hanover, MD)
- …interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied ,** **continued stay review, care coordination, and ... in a cost effective setting according to contract + Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost… more
- Elevance Health (Hanover, MD)
- **Pharmacy Quality Improvement Specialist** _This position will work a hybrid model (remote and office), 1-2 times per week. The Ideal candidate will live within 50 ... IngenioRx) leverages the power of new technologies and a strong, clinical -first lens, to deliver member-centered, lasting pharmacy care. The Pharmacy Quality… more
- Elevance Health (Hanover, MD)
- …appropriateness of care and accurate claims payment. + May also manage appeals for services denied. + Stay review, care coordination, and discharge planning ... through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications. + Facilitates… more