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Makes medical necessity determinations for grievance and appeals appropriate for their specialty. Description Clinical Operations Associate Medical Director Carelon Medical Benefit Management Interventional Pain Benefit Review Location : This position will work a hybrid model (remote and office.
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Assist the Appeals & Grievance Coordinators, Pharmacists, Medical Directors and Quality Improvement Coordinators with processing pharmacy benefit appeals and grievances.
$45,850 - $55,500 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Job Description :Clinical Operations Associate Medical DirectorCarelon Medical Benefit ManagementInterventional Pain Benefit ReviewLocation: This position will work a hybrid model (remote and office.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. 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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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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Seek to resolve differences in accordance with the scriptural patterns summarized in the Staff Manual policy on Fair Treatment as well as the Grievance and Appeals Procedure. Write and distribute PSA's and press releases.
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The Clinical Operations Associate Medical Director responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. Preferred Experiences, Capabilities, and Skills:3 years post residency or fellowship clinical expereince strongly preferred.
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Review decision letters regarding appeals and grievance for accuracy prior to delivery. Provide technical interpretations and guidance on Human Resource Management matters such as employee relations, labor relations, payroll and benefits, classification, staffing, and recruitment.
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Preferred Skills, Capabilities, and Experiences:Board certification in Pain Management strongly preferred. Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJIn addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements.
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Recommend to Program/Clinical Director action on student grievance and appeals. CSN employs only U.S. citizens and aliens authorized to work in the U.S. CSN does not sponsor aliens applying for faculty, professional staff, or management positions (H-1B Visas) in the absence of exceptional circumstances as defined by the USCIS.
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Proficient in Metavance, Formworks, and Pega (Grievance and Appeals) with an understanding of the clinical space. Fertility and diabetes benefits. If you're excited about the prospect of transforming the future of health care and growing in your career, join our smile revolution.
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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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Research and resolve grievance and appeals for the commercial line of business, utilizing a higher level of adjudicator expertise, clinical interpretation and decision making.
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Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc.
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Provides Referrals to Quality Management (QM), Disease Management, Social Services and Appeals and Grievance department (AGD). The Nurse Consultant will report to the Manager of Care Management for the Population Health Management Medi-Cal Team. In this role, you will ensure that services are provided based on standardized procedures including coordination of care with specialists and community resources.
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