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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.
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Ensure compliance with the grievance process including review of client terminations and appeals. Mental Health Respite Mission: Through professionalism, nurturance, and empowerment MHR will provide supportive services with the purpose of leading participants in personal growth and improving life skills for transitioning to the least restrictive level of care within the community environment.
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This position is assigned contract and mid-term negotiations, grievance arbitrations, statewide union management communication committees, Personnel Resources Board appeals, and may assist in the investigation of unfair labor practice complaints.
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May also engage in grievance and appeals reviews. 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.
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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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Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
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Makes medical necessity determinations for grievance and appeals appropriate for their specialty. The DMEPOS Clinical Operations Associate Medical Directo r is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers pertaining to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies.
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Serve as Hearing Officer for grievances and disciplinary appeals at the Step II level. -Professional experience with all steps of the grievance process, policy development, dispute resolution, as well as necessary familiarity with agency management and operations.
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Exposure to Public Health principles, Population Health, analytics, and use of business metrics. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work.
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Areas of oversight for this position include, but are not limited to, case management, quality management, utilization management (UM), and grievance and appeals and committee participation.
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Health Plan Core systems i.e. Claims, Membership, Grievance and Appeals. Perfict Global is a leading IT consulting services provider focused on providing innovative and successful business workforce solutions to Fortune 500 companies.
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Meets performance measurement goals for Grievance and Appeals Resolution Services. Evaluates case details, proposes recommendations, or makes decisions as applicable; ensures organization decision is implemented according to the Grievance and Appeals policies and case resolution.
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Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. A proud member of the Elevance Health family of companies, Carelon Post Acute Solutions, formerly myNEXUS, is the leader in health resource optimization, focused on transforming how healthcare is delivered and promoting the advancement of care for the people we serve.
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Board certified in Pediatrics, Physical Medicine and Rehab, or Internal Medicine or Family Medicine preferred. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
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Experience with national guidelines such as MCG or InterQualExperience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialistsExposure to Public Health, Population Health, analytics, and use of business metrics.
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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.
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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?
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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.
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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.
Hiring Transparency
Transparency in hiring refers to the open and honest communication and information sharing that takes place between employers and job candidates. It encompasses all aspects of the hiring process, from posting job descriptions to providing feedback on performance during and after the interview process. In today's job market, hiring transparency has become increasingly important for both employers and candidates alike.