- Centene Corporation (Austin, TX)
- … appeals and grievances from a clinical perspective. Ensure that the clinical Appeals and Grievance department processes all cases in accordance with ... 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
- Centene Corporation (Austin, TX)
- …deployment. + Performs recruiting, hiring, promotion, and performance evaluation tasks and counsels non- clinical Grievance and Appeals staff. + Orients and ... workplace flexibility. POSITION IS REMOTE THIS TEAM PROCESSES APPEALS ONLY Appeals Experience HIGHLY Preferred **Position Purpose:** The Supervisor of … more
- University of Utah Health (Salt Lake City, UT)
- …EO/AA_ + Supervise the day-to-day activities of staff who process member and provider Grievance and Appeals . + Monitor and set goals for staff workloads. + ... operated in accordance with applicable law. + Demonstrated understanding of insurance appeals and grievance processes. + Demonstrated experience in improving… more
- The Cigna Group (Nashville, TN)
- …related issues, implications and decisions. The Case Management Analyst reports to the Supervisor /Manager of Appeals and will coordinate and perform all appeal ... Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst We...as well as research and provide a written detailed clinical summary for the Plan Medical Director. + Determine… more
- The Cigna Group (Nashville, TN)
- Delivers specific delegated tasks assigned by a supervisor in the Utilization Management job family. Completes day to day Utilization Review tasks without immediate ... not limited to:** + Must have experience in Medicare Appeals , Utilization Case Management or Compliance in Medicare Part...as well as research and provide a written detailed clinical summary for the Plan Medical Director. + Determine… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor , Authorization Technician Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... the safety net required to achieve that purpose. Job Summary The Supervisor , Authorization Technician supports the Utilization Management (UM) Specialist by handling… more
- VNS Health (Manhattan, NY)
- …eligibility. + Coordinates with other departments, eg Care Management, Legal Affairs, Grievance and Appeals , Compliance, Membership Eligibility Unit, Quality as ... of member UAS-NY for potential new members and existing members' conditions clinical , environmental, and social to establish an individual plan of care needed… more
- The Cigna Group (Nashville, TN)
- …related issues, implications and decisions. The Case Management Analyst reports to the Supervisor /Manager of Appeals and will coordinate and perform all appeal ... **Cigna Medicare Appeals Reviewer:** We will depend on you to...as well as research and provide a written detailed clinical summary for the Plan Medical Director. + Determine… more
- State of Colorado (Canon City, CO)
- …Description + Benefits + Questions Department Information $25,000 HIRING INCENTIVE FOR FULL-TIME CLINICAL PROFESSIONALS! If your goal is to build a career that makes ... Job This position provides operational and supervisory oversight of multi-disciplinary clinical services staff working at the Fremont Correctional Facility. This… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …and actively participates in the functioning of the plan's grievance and appeals processes. + Along with the nurse supervisor and manager identify ... and procedures in conjunction with associate medical directors and other clinical staff and assures consistency and compliance with generally accepted medical… more