- Healthfirst (TX)
- …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
- Elevance Health (San Antonio, TX)
- …by analysts, medical staff or outside consultant. + Triages clinical and non- clinical inquiries, grievances and appeals , prepares case files for member ... grievance committees/hearings. + Summarizes and presents essential information for the clinical specialist or medical director and legal counsel. **Minimum… more
- Healthfirst (TX)
- …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