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The Program Manager is a key member of the Medicare Advantage Claims, Configuration and Appeals and Grievance Operations team. Assists in planning, developing, implementing, and managing the Medicare Advantage Claims, Appeals and Grievance program requirements, operational initiatives and policies.
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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. The job of the social media manager is to manage the social media accounts (mainlyInstagram) of the Center for Calling and Career.
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Interface with Grievance and Appeals, Claims, Enrollment, IT, Network Management, Pharmacy, Authorizations, and other internal departments to provide Service Excellence to our members.
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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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Commercial Grievance and Appeals knowledge is highly preferred. Experience and knowledge with PEGA NextGen is highly preferred. This position will work a hybrid model (remote and office.
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Makes medical necessity determinations for grievance and appeals appropriate for their specialty. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Review Level of Care for iCare members including follow-up consultation with Grievance and Appeals or Enrollment/Eligibility/Fiscal staff. The Screener is responsible for screening members within the iCare Family Care Partnership service areas, as well as participate in all iCare and WI State LTCFS required compliance and quality assurance activities.
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The Claims Supervisor is responsible for the day-to-day management of the Senior Analyst claims team, who handle a variety of tasks including, but not limited to, Customer emails, Correspondences, Grievance and Appeals, HRA, Balance Bills and Transplants, enabling the team to deliver exceptional service to our customers.
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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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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.
Part-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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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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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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Under general supervision of the Grievance and Appeals Manager performs a variety of complex, responsible and confidential duties requiring a thorough knowledge of organizational procedures and precedents perform routine clerical, administrative duties in support of the Grievance and Appeal Department.
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We are seeking a talented Grievance & Appeals Specialist who will be responsible for responding to written/verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with NCQA, CMS, State, and other regulations.
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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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