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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 23 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-timeExpandApply NowActive JobUpdated 2 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 23 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 23 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 23 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 2 days ago - 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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