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Maintain job duties as a Clinical Appeals Nurse (Appeal writer) with billable hours. The Clinical Appeals Nurse will perform quality assurance audits, assist in orientation and training of Clinical Nurses, and assist in planning, implementation, and execution of department and organizational goals.
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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.
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Job DescriptionAcentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job Summary:Our Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations.
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Represent the City: in civil appeals filed in Municipal Court, including dangerous animal and unlawful towing appeals; on appeals of Class C Misdemeanors; and state court appeals.
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When necessary, Appeals Officers prepare the Agency's written position statement and presents it orally before a hearing officer and/or State Administrative Law Judge. Under supervision, Appeals Officers analyze welfare case records when clients or applicants have appealed an action of the Social Services Agency.
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Under the supervision of the Appeals and Grievance Manager, assist with soliciting non-clinical information from Participating Physical Group (PPG) and specialist concerning follow care related to care management.
$47,840 - $68,474 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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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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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 Today - UpvoteDownvoteShare Job
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Additionally, unique opportunities are afforded to Assistant District Attorneys who show great interest or possess the specialized experience to work within the Office’s Writs and Appeals Unit. This Unit is comprised of experienced attorneys who handle cases in the Superior Court, Court of Appeal, and Supreme Court of California.
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Duties:Represent clients in patent litigation matters, including district court proceedings, Federal Circuit appeals, PTAB proceedings, and related cases. The role involves handling patent infringement litigation in district court, Federal Circuit appeals, PTAB proceedings, tech transactions, and patent-adjacent cases such as antitrust and trade secret matters.
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Working as a member of the Appeals Court Clerk's Office, the Research Attorney assists the Clerk and Assistant Clerks in performing their legal and administrative duties, works directly with Justices in the Appeals Court single justice and panel sessions, and assists the public by answering procedural questions.
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The OCE serves the Court of Appeals as well as all of the District Courts, Bankruptcy Courts, Probation and Pretrial Services Offices, and Federal Public Defender's Offices within the Ninth Circuit.
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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.
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We are recruiting for a Grievance and Appeals Specialist - Denver Health Medical Plan to join our team! Must have a thorough understanding and working knowledge of managed care, health insurance plans, regulatory, and other policies and procedures, including grievance and appeals practices.
$51,098 - $69,133 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Combine in-depth analysis of business unit requirements and comprehensive understand of core system capabilities, knowledge of claim processing, provider and vendor setup, authorizations and business processes in order to determine optimal core system setup to process claims, case management, and grievance and appeals with a high degree of accuracy and auto-adjudication.
$104,280 - $161,634 a yearFull-timeExpandApply NowActive JobUpdated Yesterday
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