- Centene Corporation (Salem, OR)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. + Maintain files and logs for all appeals +… more
- Sharp HealthCare (San Diego, CA)
- …with the Chief Medical Officer (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is ... responsible for non- clinical appeals and grievances. **Required Qualifications** + 3 years' experience in claims, utilization review, appeals or member… more
- Sharp HealthCare (San Diego, CA)
- …with the Chief Medical Officer (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is ... responsible for non- clinical appeals and grievances. **Required Qualifications** + 3 years' experience in claims, utilization review, appeals or member… more
- CVS Health (Columbus, OH)
- …Summary** Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more
- Centene Corporation (Sacramento, CA)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- Centene Corporation (Phoenix, AZ)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- Healthfirst (FL)
- + Prepare cases for the clinical team by gathering documentation, loading evidence, and making calls to members and providers. + Perform administrative activities ... + Correctly and completely preps completed case files for clinical review. + Notifies team lead of identified patterns...review. + Notifies team lead of identified patterns of appeals , claim errors, configuration issues or other systemic problems… more
- Commonwealth Care Alliance (Boston, MA)
- …, operations, pharmacy, dental, reporting, and member services. + Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day ... 011540 CCA- Appeals & Grievances **Position Summary** Appeals ...strict deadlines. + When necessary collaborate with care teams, clinical staff, family members, and other involved in providing… more
- Meijer (MI)
- …and career growth Please review the job profile below and apply today! The Clinical Care Coordinator acts as a liaison and coordinates communications between the ... be an expert in all stages of filling specialty medication prescriptions. The Clinical Care Coordinator works to ensure all specialty service expectations are… more
- Squirrel Hill Health Center (Pittsburgh, PA)
- …Health Center (SHHC), is a Federally Qualified Health Center (FQHC), seeking a dedicated Clinical Support Coordinator to join our team. The ideal candidate will ... and insurance companies to streamline the authorization process. The Clinical Support Coordinator will assist SHHC Providers...of approval or denial statuses, including next steps for appeals if necessary. + Documentation: + Accurately… more
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