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The Grievance and Appeals Coordinator will also present cases to the Appeals Committee. The Appeals and Grievance Coordinator will coordinate, process, and document all aspects of member appeals and grievances, as well as provider appeals across all our product offerings (Commercial, Medicaid and Medicare.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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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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Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol. Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol.
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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.
ExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Negotiate settlements in connection with grievance disputes and collective bargaining activities. Administer the contractual grievance process. Reporting directly to the Deputy Commissioner of Human Resources and Facilities Management (HRFM), the Director of Labor Relations will administer the Agency's labor relations program.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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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. May also engage in grievance and appeals reviews.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Serves on Quality Improvement & Health Equity Committee, Peer Review and Credentialing Committee, Grievance and Appeals Committee, Clinical Operations Committee and Physician Advisory Committees; serves on other committees as required.
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In-depth knowledge of all aspects of managed care medical management, including UM/CM, Grievance and Appeals, medical policy, clinical claims review (professional and facility), and delegated vendor oversight.
RemoteExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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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.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Makes medical necessity determinations for grievance and appeals appropriate for their specialty. Makes medical necessity determinations for grievance and appeals appropriate for their specialty.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Can hold grievance hearings or appeals / Conduct investigation depending on nature of matter. Reporting into the Senior HR Business Partner, you will advise on the most complex processes, queries or issues to resolution, implementation of corporate policies, supporting Managers by addressing root causes of issues.
ExpandApply NowActive JobUpdated 13 days ago - UpvoteDownvoteShare Job
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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.
$51,000 - $78,122 a yearFull-timeExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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The ideal candidate will be well versed in the Medicare managed care appeals and grievance process. Medicare Appeals Specialist. 3 to 5+ years of recent experience writing insurance appeals and pursuing Medicare for collection on behalf of hospitals (facility charges.
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