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The Navitus Grievance & Appeals Coordinator serves to administrate the Navitus Grievance and Appeals processes as outlined by Client/Plan Sponsors, departmental policies and procedures, and regulatory standards.
$19.03 - $23.73 an hourRemoteExpandUpdated 28 days ago - UpvoteDownvoteShare Job
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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.
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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.
$25 - $31 an hourFull-timeExpandUpdated 28 days ago - UpvoteDownvoteShare Job
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From 2021 to 2023, WPS Health Solutions was recognized for several awards: Role Snapshot Our Appeals Nurse will examine medical records and claims information for first-level appeal cases to determine whether services provided were medically necessary and meet Medicare coverage guidelines in accordance with Medicare regulations and policies.
Full-timeRemoteExpandUpdated 28 days ago - UpvoteDownvoteShare Job
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Provide case management for patent litigation in federal district courts, appeals before theFederal Circuit Court of Appeals, and actions before the U.S. International Trade Commission,USPTO, and Patent Trial and Appeal Board.
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The Office handles cases in the County’s District Courts (including Jury sessions), Juvenile Courts, and Superior Court, and is responsible for all appeals to the State Appeals Court and Massachusetts Supreme Judicial Court.
$90,000 - $110,000 a yearFull-timeExpandUpdated 28 days ago - UpvoteDownvoteShare Job
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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 3 months ago - UpvoteDownvoteShare Job
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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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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.
$24.52ExpandUpdated 28 days ago - UpvoteDownvoteShare Job
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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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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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Case types include Adoption, Civil, Criminal, Family Law, Guardianship/Conservatorship, Juvenile Delinquency, Juvenile Dependency, Juvenile Emancipation, Lower Court Appeals, Mental Health, Probate, Protective Orders and Severance cases.
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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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Participate in litigation on cases involving immigrant access issues and state court appeals of final MassHealth determinations as needed. Represent clients in communications and negotiations with MassHealth and Health Connector officials, health care providers, managed care entities, and in appeals before the Office of Medicaid Board of Hearings.
$72,000 - $80,000 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The RN Clinical Appeals Nurse will actively manage, maintain and communicate denial/appeal activity to appropriate stakeholders, and report suspected or emerging trends related to payer denials.
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appeals job
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Virtual Reality Job Interviews
With the advent of desktop computers, the arduous task of scouring through weekly job classifieds became a thing of the past. The mid-1990s brought about a new era where job seekers could easily search and apply for jobs online. The introduction of AOL's Instant Messaging feature provided an even faster means for employers and candidates to communicate and schedule interviews. As smartphones became more pervasive in the early 2000s, hiring managers increasingly used phone calls for screening and interviewing candidates. Despite this trend, over 80% of interviews still took place in person.
A Potential TikTok Ban?!
As you may already know, there has been a lot of talk lately about the possibility of a TikTok ban. While this has not yet come to fruition, it's important to consider the implications this could have for businesses and recruiters who rely on TikTok as a platform to market their brand, recruit new talent, and connect with their audience.
The Effects of Workplace Racism and Sexism
One day it's a covert statement to a mother returning to work after maternity leave. Another day it's a lingering gaze at an employee enjoying a culturally rich meal. These microaggressions (or sometimes macroaggressions) can take an employee from a confident, high-performer to one that feels insecure being themselves at work. Your employees engage with people with different ideas and feel most comfortable and valued when they can work without losing their cultural, racial, and gender identity. While most employers know this, why have workplace racism and sexism often been neglected?
When Rage Applying Strikes: How to Identify Unserious Candidates
As the job market remains highly competitive, we have seen a surge in "rage applying." This is when candidates apply to multiple jobs, often without considering whether they are truly interested in the role. Rage applying goes hand-in-hand with quiet quitting. Often, employees want to entertain the thoughts and feelings of leaving their job, but they aren't necessarily serious about leaving yet. Meanwhile, other employees engaging in this trend are actually trying to find a better role. As a recruiter, it can be hard to identify who are the real applicants in a sea full of quiet quitters, but understanding rage applying and identifying red flags will certainly help.
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In today's competitive job market, writing quality job ads is critical for attracting top talent to your organization. While networking and candidate referrals are prime real estate for finding qualified candidates, nothing beats the tried-and-true method of writing an extraordinary job ad. But while writing a great job ad is the first step, what's more important is increasing visibility. You could have the most detailed, well-written ad on the internet, but if no one sees it, then you are wasting time (and potentially money!). Employers often believe that job boards are the root of the problem, but you can learn how to increase job ad exposure by tweaking a few steps of your recruitment process.
How to Navigate Hiring Out of State
The job market has shifted significantly in recent years. The accelerated adoption of technology has not only pushed many companies into remote working arrangements but also increased the availability of supporting tools and technologies (i.e., video conferencing and collaboration software).
Building a Candidate Pipeline Through Internships
Building a candidate pipeline through a great internship program for local college students and recent graduates at local universities is a great and cost-effective way to attract and retain top talent. By offering meaningful and impactful work experiences, regular feedback, coaching, and mentorship, you can create a positive internship experience that will make your organization a sought-after destination for future employees. This not only benefits the organization in the short-term but also in the long-term, as you'll have a pool of well-trained and experienced candidates who may be interested in full-time employment once they graduate. Furthermore, building relationships with local universities and college students can increase brand awareness and build a positive reputation for your organization in the local community.