- Robert Half Accountemps (Ontario, CA)
- …remote - may require the odd trip to the office to process mail Role Responsibilities: Point of contact for Health Plan member grievances and internally identified ... potential quality of care issues PQI. Responsible for coordinating the process with receipt and initial processing including data entry record requests and follow ups for member grievances and other quality of care concerns from internal and external sources.… more
- Elevance Health (Columbus, OH)
- …for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of medical ... medical necessity decisions. + Brings to their supervisor's attention, any case review decisions that require Medical Director review or policy interpretation.… more
- UNC Health Care (Goldsboro, NC)
- …and conduct of administrative and/or judicial, local and up to State appeals . 7. Gathers and provides necessary verification to establish Medicaid eligibility via ... to patient's homes in order to complete the Medicaid Applications/forms. 19. Review accounts for Newborns and add coverage including completing Medicaid screenings… more