• Appeals and Grievances…

    Healthfirst (GA)
    …degree + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization management/case ... and Responsibilities:** + Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity,… more
    Healthfirst (09/09/25)
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  • Emory Health Plan, Vice President - Plan…

    Emory Healthcare/Emory University (Atlanta, GA)
    …card distribution, accurate provider directories, performance on VBC contracts, benefit adjudication, appeals , and grievances . + Collaborate with the TPA to ... the VP Pharmacy for performance on pharmaceutical spending targets, and the clinical team for population management. STRATEGICE PLANNING AND PROCESS IMPROVEMENT: +… more
    Emory Healthcare/Emory University (08/19/25)
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