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Must be eligible for certification by the Miami-Dade County Board of Rules and Appeals. Must meet all other licensure requirements set forth by the Miami-Dade County Chapter 8 and the Board of Rules and Appeals.
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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.
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Amentum is seeking a Paralegal to assist with the USCIS litigation support team on Visa Petition Appeals Records of Proceeding (ROP) and E-ROPs. Under close guidance and supervision, the paralegal will follow decision-tree-like guidance to match case files to help ensure case files are have complete, accurate and timely documentation including decisions, appeals processes, etc.
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Assistant Prosecutors in the Child Support Unit represent the local child support enforcement agency in civil matters involving paternity, child support establishment, and modification and enforcement before the Cuyahoga Common Pleas Court, Divisions of Domestic Relations and Juvenile, and Courts of Appeals.
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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.
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This position has the responsibility of building patient accounts in the denials management system and performing timely follow-up with regard to clinical and medical necessity insurance appeals.
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The Grievance and Appeals Nurse Specialist participates in managing CalOptima Health's medical appeals and state hearing reviews for all lines of business, including handling expedited and standard requests.
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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.
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Summary We are seeking a talented individual for a Nurse Reviewer Appeals and Hearing to coordinate and perform all appeal-related duties including analyzing and responding appropriately to appeals from providers; reviewing documentation to ensure all aspects of the appeal have been addressed properly and accurately; preparing case files and case summaries for hearings; and participate in virtual and on-site hearings.
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The Division's mission is to represent Navy and Marine Corps appellants before the Navy-Marine Corps Court of Criminal Appeals (NMCCA), the U.S. Court of Appeals for the Armed Forces (CAAF), the U.S. Supreme Court and, occasionally, the Naval Clemency and Parole Board.
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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.
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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.
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Claims Management Hartford , Connecticut Apply Now 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) Preferred Qualifications.
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Claims Management Atlanta , Georgia Apply Now Become a part of our caring community and help us put health first. 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.
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Claims Management Saint Paul , Minnesota Apply Now Become a part of our caring community and help us put health first. Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.
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