- Centene Corporation (Columbus, OH)
- …division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point ... groups, and/or ancillary providers within assigned area. + Act as account manager for assigned groups acting as gatekeeper for interactions with other internal… more
- Healthfirst (NY)
- …but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions** + **Partner ... discipline and capacity for executive-level decision-making** + **Experience working as a case manager for a long-term care programs such as PACE, MAP or MLTC.** +… more
- New York State Civil Service (Albany, NY)
- …of their legal rights, advises them of complaint filing procedures, assist with appeals / grievances , or refers them to other government or private agencies. * ... and prepares memoranda. * Coordinates with Assistant Attorney General/ Helpline Manager to identify cases involving potential violations or systemic issues that… more
- Beth Israel Lahey Health (Westwood, MA)
- …address information. Escalates calls to pharmacists for clinical inquiries and escalates grievances to supervisor. 7. Maintains new and existing patient profiles and ... Support health care providers with required prior authorization and required appeals . Manage all mail/delivery of Rx orders including addressing problems/issues with… more
- Elevance Health (Pembroke Pines, FL)
- …relevant parties of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more