- UpvoteDownvoteShare Job
- Suggest Revision
The Clinical Appeals Nurse will review each case identified/referred for appeal based on Milliman Care Guidelines (MCG), InterQual, and/or other relevant guidelines, determined the viability of the appeal, and manage the appeal process.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Represents the department at meetings, hearings, and in court by preparing evidence and/or appearing before such bodies as the Board of Supervisors, Building Inspection Commission, judicial committees, Access Appeals Commission, Unreinforced Masonry Building Appeals Board, Board of Permit Appeals, Abatement Appeals Board, and Board of Examiners in order to testify or present information regarding code violation cases and other matters concerning their respective division(s.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
The Grievance and Appeals Coordinator will also present cases to the Appeals Committee. The Appeals and Grievance Coordinator will coordinate, process, and document all aspects of member appeals and grievances, as well as provider appeals across all our product offerings (Commercial, Medicaid and Medicare.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Attorneys also respond to habeas corpus litigation in the United States District Court, the Ninth Circuit Court of Appeals, and the United States Supreme Court. Deputies can expect frequent oral arguments in the California Court of Appeal, as well as occasional appearances in the California Supreme Court, the United States District Court, Central District of California, and the Ninth Circuit Court of Appeals.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Our Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations.
$24 - $35 an hourFull-timeExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Department(s): Grievance & Appeals Resolution Services (GARS)Reports to: Manager, Grievance & AppealsSalary: $24.52 - $31.04 Duration: up to 6 months Job Summary The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Makes presentations and reports to and for the Planning Zoning & Appeals Board, the City Commission, and the City Manager. Prepares and reviews reports and recommendations to the Planning Zoning & Appeals Board and the City Commission on matters affecting land use and zoning changes and makes presentations at public hearings.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
The Senior Litigation Counsel works under minimal supervision to litigate nationwide non-disciplinary and disciplinary proceedings filed with the Office of Hearing Officers (OHO) and to brief and argue appeals before the National Adjudicatory Council (NAC.
$152,700 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. May also engage in grievance and appeals reviews.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Documentation: Maintain detailed records of pre-authorization requests, approvals, denials, and appeals, ensuring compliance with regulatory requirements and internal policies. Authorization Appeals: Prepare and submit appeals for denied pre-authorization requests, providing necessary documentation and supporting information to overturn denials.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
As a remote nurse, you'll be part of an interdisciplinary team that appeals denials on behalf of each patient you support. Job DescriptionAdditional Information About the Role Join our team as a Clinical Appeals Registered Nurse and advocate for patients in a unique way.
$68,224 - $104,811.2 a year depends on experienceFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Become a part of our caring community and help us put health first. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
The clinical scenarios predominantly arise from inpatient or post-acute care environments. Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
The Deputy Chief Counsel is responsible for the leadership, support, training and oversight of private bar panels in criminal, sexually dangerous person and sex offender registry cases, and in appeals and post-conviction cases related to those matters.
ExpandApply NowActive JobUpdated Yesterday
appeals job
FEATURED BLOG POSTS
How to Answer the Interview Question: What is Your Communication Style?
As a job searcher, you probably have so many questions about job searching. However, once you've landed an interview, your excitement takes your questions to a whole new level. What will you wear? Will you know how to answer all the questions? Have you practiced giving nice firm handshakes?
What Makes a Company a Great Place to Work
After one too many after-hours emails, you’re on the hunt for a new gig. But what makes a company a great place to work? And how will you know when you find one? Finding a motivating, safe, and productive work environment is important for our mental and physical health. If you’re financially frustrated, creatively stuck, or just plain over it, it’s time to find a healthier workplace where you can flourish.
What Makes a Good Boss? The Top 12 Qualities & Attributes
Think back to the best boss you’ve ever had—does someone come to mind? We hope so! Okay, now think back to the worst boss you’ve ever had. I’m sure you can conjure up a few faces.
How to Recruit and Retain Gen Z Employees
As Boomers and the oldest Gen X are exiting the workforce, younger Millennials and Gen Z are flowing in. While the younger generations seem to be completely different than the older generations, many care about some of the same things- financial security, working conditions, etc. However, due to social and cultural differences in the era that Gen Z has grown up in, they have concerns that were never even workplace topics of discussion 20 years ago.
How Does Temp to Hire Work? Benefits, Concerns, & More
Whether you’re just starting out your career or are looking for the next opportunity, the job market has never been more burgeoning with opportunities. From flexible work options and freelancing gigs to seasonal and temp-to-hire work, people today are spoiled for choice when it comes to finding engaging and fulfilling work.
Explore Your Skill and Find the Best Way to Make Money From Home
When you just can’t stomach another drive-thru coffee on your morning commute, close your navigation app on your phone and search for easy ways to make money from home instead. With a computer and some niche skills, there are countless opportunities for you to earn a living from your couch. (Okay, fine, your home office.) Below, we’ll explore 30 different ways to make money from home, as well as a few “too-good-too-be-true" warning signs to know to keep you from booking the wrong remote gig.
What is Employment Participation Rate
According to economists, there are four factors of production that go into creating higher quality goods at lower prices. These are