- CVS Health (Hartford, CT)
- …**Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from clinical records to ... as required. This position may support UM, MPO, Coding, or Behavioral Health appeals . **Required Qualifications** + Must have active and unrestricted RN licensure in… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- Defense Health Agency (Edinburgh, IN)
- …the Medical Evaluation Board (MEB) Clinical Psychologist subject matter expert and consultant for the development of the psychiatric portion of the Narrative Summary ... the Supervisory Physician (MEB) in the Medical Evaluation Board Remote Operating Center (MEBROC), an MEB virtual processing site...and is called upon to serve as an adviser, consultant , or resource person to other providers and inter-disciplinary… more
- Centene Corporation (Tallahassee, FL)
- …Develop and maintain the audit process and tools related to: authorizations, appeals , quality events, and case management in CCMS; interrater reliability related to ... compliance with the auditing process + Act as a consultant related to system auditing to others in the...Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), Registered Nurse (RN), or Licensed Psychologist (Ph.D. or Psy.D.) This… more