- Healthfirst (PA)
- …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
- VNS Health (Manhattan, NY)
- OverviewResolves grievances , appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare ... each grievance or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with… more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal ... of clinical nursing and medical practices, the Clinical Appeals Specialist will review...will be responsible for tracking, trending and monitoring of appeals , grievances , NYS external review, and making… more
- Healthfirst (NY)
- …and non-par provider appeals . The end to end process requires the Specialist to independently: + Research issues + Understand claim denials + Communicate with ... Additional duties as assigned **Minimum Qualifications:** + Proven work experience with appeals and grievances or healthcare environment. + Work experience… more
- Arab Community Center for Economic and Social Serv (Dearborn, MI)
- …to access services and rights processes + Assist with resolution of local complaints, grievances , and appeals processes + Survey, track, trend, and report on ... Intake & Customer Service Specialist Department: Community Health & Research Center Location:...are significant changes to the client history or other clinical issues that are presented) + Strong customer service… more
- Centene Corporation (Sacramento, CA)
- …available services. + Researches and prepares conflict resolution documentation to support Appeals and Grievances . + Prepares and submits monthly and quarterly ... 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,… more
- Healthfirst (NM)
- …as needed. + Request denial files from delegated vendors and prepares cases for Clinical Specialist reviews. + Maintains file integrity with regards to content ... or 5x8 work schedules** + Prepare cases for the clinical team by gathering documentation, loading evidence, and making...Claims, DSE, and E&B to resolve member and provider appeals . + Ensures appeals and grievances… more
- State of Colorado (Canon City, CO)
- …plans; + Diagnose and treat dental disease of offenders or refer offenders to specialist for treatment; + This position may be required to participate in restraining ... of care; + Collaborate with other health care professionals, clinical services staff regarding offender health issue/policies, transfers, classifications and… more
- State of Colorado (Denver, CO)
- …Description of Job This position will perform routine support services and clinical tasks for the incarcerated offenders in either an outpatient clinic, infirmary, ... primarily for medical reasons; + Perform all types of clinical support services necessary for the operations of a...supplies for store rooms and examination rooms; + Coordinate grievances by logging and mailing back responses. Complete flow… more
- State of Colorado (Denver, CO)
- …of accuracy in order to meet legal requirements. This position serves as clinical administrative support to multi-disciplinary staff. Duties are as follows, but not ... health care information; + Execute, copies and distributes the release of clinical information from health records; + Request clinical information from… more