- 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.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
- Suggest Revision
May also engage in grievance and appeals reviews. Become a part of our caring community and help us put health first. 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 2 days ago - 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 14 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
ExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Humana Medical Director- South Central Cheyenne , Wyoming Apply Now Become a part of our caring community and help us put health first. Exposure to Public Health principles, Population Health, analytics, and use of business metrics.
ExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Comprehensive understanding and ability to interpret federal and state government (DHCS and CMS) guidelines, and eligibility and enrollment process in order to setup core systems for claims, case management, and grievance and appeals.
ExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work. Satellite, cellular and microwave connection can be used only if approved by leadership.
ExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Coach and train staff to identify the potential quality of care/service and accessibility concerns and refer to Grievance and Appeals (G&A), Case and Disease Management (CM/DM), Behavioral Health/ABA or Quality Improvement (QI.
RemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
- Suggest Revision
The Program Manager is a key member of the Medicare Advantage Claims, Configuration and Appeals and Grievance Operations team. Assists in planning, developing, implementing, and managing the Medicare Advantage Claims, Appeals and Grievance program requirements, operational initiatives and policies.
RemoteExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
The Program Manager leads and manages key operational programs, initiatives and strategic projects that span across the functional teams of Claims, Configuration and Appeals and Grievances.
RemoteExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Supports the assigned work with respect to market-wide objectives (e.g. Bold Goal) and community relations as directed. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.
ExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Areas of oversight for this position include, but are not limited to, case management, quality management, utilization management (UM), and grievance and appeals and committee participation.
$115.71 - $159.1 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Experience in aged claims management and grievance and appeals processing is highly desirable. Job Description: Appeals Coordinator (Hybrid Position)Our client, a leading company specializing in non-invasive skin cancer treatment, is seeking an experienced and detail-oriented Appeals Coordinator to join their team.
Up to $22 an hour (competitive)Full-timeExpandApply NowActive JobUpdated Today
appeals and grievance jobs
FEATURED BLOG POSTS
Why is Non-Verbal Communication Really Important?
In a world where words and phrases rule daily communication, you may wonder why non-verbal communication is important. Whether you realize it or not, you communicate more with nonverbal actions than you do with verbal communication. When you interact with your peers, people are reading your body language, facial expressions, voice, and many other factors that help fill in blanks that words can't fill.
Making Hybrid Work More Efficient
Covid was a catalyst for change in the work environment. Keeping people safe and helathy was the initial goal for employers, but the unintended result was the considerable demand in remote work. Now, onsite work has been dramatically altered to remote work, which is now transforming into a combination of the two: hybrid work.
How Can HR Technology Help Retain Employees?
Human resources' rapid adoption of technology has led to new ways of streamlining human capital management. Based on the IEE Global Study, these technologies changed how HR handled recruitment and retention in 2022. This includes tech like
Why is Time Management Important? 10 Crucial Importances of Time Management
We’ve all been there before. What starts as a relaxing evening scroll quickly becomes a full-blown binge. You blink, and it’s midnight - throwing off your entire next day before it even starts. And at its worst, this indulgence might leave you feeling behind on things you planned to finish that night. This is why time management is important.
Minimizing Candidate Renegs During the Hiring and Onboarding Process
Candidates reneging on job offers or during the onboarding process can be a frustrating experience for any recruiter. In a talent-driven job market, it’s common for candidates to have more than one job offer to consider. It becomes a race against time to see which organization can offer the best career experience, compensation, and circumstances that secure the right employees.
10 Reasons to Be on Time at Work
Being punctual at work may not be something you’ve given much thought to, but it’s the foundation for building a successful career. All of your technical or job-specific skills will be in vain if your peers and superiors can’t trust you to show up on time and do the work. In fact, Simon Sinek once famously said that
10 Importancies of Setting Realistic Goals
We’ve all heard how important it is to set professional and personal goals. Developing and establishing goals keeps us motivated and moving forward in life. But not all goals are created equal. If you’re chasing goals that are too lofty, you’ll end up disappointed when you cannot reach them. Setting goals that are achievable and measurable is the key to success.