• Appeals and Grievances…

    Healthfirst (ME)
    …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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  • Appeals Quality and Training…

    Martin's Point Health Care (Portland, ME)
    …has been certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This ... CMS Part C and Part D Organization Determinations and Grievances guidance. + Prepares files and participates in both...projects. + Independently partners with Medical Directors and other clinical support staff on appeals requiring … more
    Martin's Point Health Care (09/04/25)
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