- UpvoteDownvoteShare Job
- Suggest Revision
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 17 days ago - 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.
ExpandUpdated 17 days ago - UpvoteDownvoteShare Job
- Suggest Revision
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-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
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 17 days ago - UpvoteDownvoteShare Job
- Suggest Revision
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.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
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 17 days ago - 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 3 months ago - UpvoteDownvoteShare Job
- Suggest Revision
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.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
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.
$24.52ExpandApply NowActive JobUpdated Today - 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
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.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
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.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
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.
ExpandUpdated 17 days ago - UpvoteDownvoteShare Job
- Suggest Revision
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
- Suggest Revision
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.
ExpandUpdated 17 days ago
appeals job
FEATURED BLOG POSTS
Recruiting in a Recession: Hard Truths That Talent Acquisition Experts Must Accept
The summer had economists from around the globe embroiled in a debate about a possible recession coming in the next few years (or months). As of October 2022, the U.S. Labor Department data put the current inflation rate at 7.7%. The recent layoffs in the tech industry are just the first of what is soon to be a string of cutbacks by companies looking to save costs. For recruiters, this means freezes in hiring and fewer openings. It will also include the uphill task of finding the best candidates for them from the coming influx of recently laid-off job seekers. Now is probably a good time to brace for tough times in the next few years in the talent acquisition industry. To survive and thrive recruiting in a recession, here are some hard truths you will need to accept.
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.
Email Etiquette Principles - Why is it Important
Why is email etiquette important? Let's imagine you're hiring for a new role, and you’ve just received the email below.
10 Reasons HR is Important to an Organization
"Nothing we do is more important than hiring and developing people."
7 Importances of Organizational Culture and How to Build It
The world of work has drastically changed in the past few years. Where a good salary and a nice office might have been enough to attract talent in the past, employees today expect flexibility, growth opportunities, and a healthy work environment. In fact, 77% of applicants say they’d consider a company’s culture before applying for a job.
Collaborative Recruiting: The Key to a Better Talent Acquisition Strategy
Talent acquisition is a multi-stage process where candidates undergo various application steps before getting hired. The unfortunate reality is that it is a labor-intense system, with the hiring manager and recruiter often handling all of the work on their own. Ask any one of them, and you will hear about the overabundance of applications and the demanding task of filtering through them to find the best candidates. The quality of talent suffers under the weight of all that work on one person's hands. It's not easy, but as many companies are starting to realize, there is a better way. The future of talent acquisition lies in collaborative recruiting!
4 Talent Acquisition Trends Going Into 2023
For better or worse, a side effect of the COVID-19 pandemic was a marked shift in talent acquisition practices worldwide. With the struggle to retain talent that began in 2020, companies have had to rethink recruitment strategies. The result has been new talent acquisition trends that are well on their way to becoming commonplace. These are the practices that are going to become even more widespread going into 2023.