- Molina Healthcare (Idaho City, ID)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
- Molina Healthcare (San Bernardino, CA)
- …medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse ... and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +...Experience" sections detailed on my application and that scoring appeals will not be allowed for this recruitment. 07… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana ... estimates for waivers. + Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label and off-label waivers and… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +...Experience" sections detailed on my application and that scoring appeals will not be allowed for this recruitment. 06… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +...Experience" sections detailed on my application and that scoring appeals will not be allowed for this recruitment. 10… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +...Experience" sections detailed on my application and that scoring appeals will not be allowed for this recruitment. 07… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +...Experience" sections detailed on my application and that scoring appeals will not be allowed for this recruitment. 08… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +...Experience" sections detailed on my application and that scoring appeals will not be allowed for this recruitment. 07… more
- CVS Health (IL)
- …in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) ... to incoming correspondence and internal referrals. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs… more