- Healthfirst (NY)
- …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 (NY)
- …as: certain types of claim denials, member complaints, and member and provider appeals . The end-to-end process requires the Specialist to independently: + ... Work within a framework that measures productivity and quality for each Specialist against expectations + Additional duties as assigned **Minimum Qualifications** +… 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
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal… more
- BayCare Health System (Clearwater, FL)
- …and clinical excellence. **Summary:** + Handles and processes customer appeals and grievances in accordance with established guidelines, company policies, ... and legal regulations. + Receive and document customer appeals and grievances via multiple channels (phone, email, online portals) in systems. + Ensure accurate… more
- State of Colorado (Pueblo, CO)
- Youth Services Specialist II - Pueblo Youth Service Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4812948) Apply Youth Services ... Specialist II - Pueblo Youth Service Center Salary $59,184.00...Recommends any modifications of the program to supervisory and/or clinical staff. Facilitates and monitors cleanup of pod and… 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
- Arab Community Center for Economic and Social Serv (Sterling Heights, MI)
- …to access services and rights processes - Assist with resolution of local complaints, grievances , and appeals processes - Survey, track, trend, and report on ... Intake and 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
- FLACRA (Clifton Springs, NY)
- …closely with Managed Care insurance providers to understand their policies, including grievances and appeals , and assist clients with advocacy as needed. ... Utilization Management Specialist Clifton Springs, NY (Onsite) Full-Time $16.50 -...of stay criteria. + Perform preauthorization and continued stay clinical reviews for insurance companies within the required time… more
- Dignity Health (Bakersfield, CA)
- …manner to the health plan. - Partners as needed with the appeals and grievances functions of the department. **Qualifications** **Minimum Qualifications:** ... Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a… more