- Sharecare (Concord, NH)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for:** + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Sharecare (Concord, NH)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- HCA Healthcare (Rochester, NH)
- …At Frisbie Memorial Hospital, our nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want to create your own personal career ... payors, and hospital-negotiated contracts. Assists medical staff in responding to appeals . Provides requested information regarding patient care and services to… more
- CVS Health (Concord, NH)
- …in accordance with contract. + Process claim referrals, new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. ... + Assists providers with credentialing/re-credentialing and contracting questions and issues. + Assist in compiling claim data for audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming… more