- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and assigning all incoming… more
- Elevance Health (Indianapolis, IN)
- …records of denied services for medical necessity. + Extrapolates and summarizes medical information for medical director , consultants and other external ... or overturn (approve) requested appealed service and forwards to Medical Director for final review and decision....final review and decision. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. +… more
- State of Colorado (Golden, CO)
- …security/control functions, educational support services, daily programming, recreation, meals, medical referral and follow-up, and customer service. Responsible to ... professional development training (as available) + Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, in… more
- State of Colorado (Denver, CO)
- …security/control functions, educational support services, daily programming, recreation, meals, medical referral and follow-up, and customer service. Responsible to ... ongoing professional development training (as available). Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, in… more
- Peak Vista (Colorado Springs, CO)
- …programs and education. We provide integrated health care services including medical , dental, and behavioral health through our 20 outpatient health centers. ... be prorated for PT employees. Summary of Benefits: + Medical , Dental, Vision, Life, STD, LTD + 403(b) Retirement...outcomes. + Provide timely updates and reports to the Director of Population Health, QI Committee, Executive Team, and… more
- WMCHealth (Margaretville, NY)
- …+ Keep abreast of economic conditions/situations and recommend to the Activity Director adjustments in activity programs that assure the continued ability to provide ... forms, reports, etc., and submitting such to the Activity Director as required. + Committee Functions + Serve on,...before entering a resident's room. + Review complaints and grievances made by the resident and make a written/oral… more
- Cognizant (Annapolis, MD)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a... Medicare , Medicaid, and third-party guidelines. . Effectively document and… more
- State of Colorado (Jefferson County, CO)
- …disabilities living in Colorado. Admissions are for individuals with complex behavior and medical needs who may pose a risk to themselves or the community. We ... individuals who have profound and severe disabilities with a high level of medical needs, and/or have significant behavioral and psychiatric challenges. The focus of… more
- Cedars-Sinai (Beverly Hills, CA)
- …Express) no later than date of discharge. + Communicates regularly with CSMPN Medical Director , Employee Health Services, Risk Management, and TPA + Attends ... 19 years in a row for providing the highest-quality medical care in Los Angeles. We were also awarded...Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and… more
- Atlantic Health System (Morristown, NJ)
- …athletes, coaches, and medical staff as indicated 9. Manages and resolves complex grievances related to the medical care provided to athletes 10. Acts as ... AHS affiliated School or Team Organization to autonomously provide medical care to all athletes affiliated with designated School...highest - twelve consecutive times, and the Centers for Medicare and Medicaid Services awarded us again with its… more