- UpvoteDownvoteShare Job
- Suggest Revision
Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
May also engage in grievance and appeals reviews. Humana Medical Director - Southeast Region Richmond , Virginia Apply Now Become a part of our caring community and help us put health first.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Humana Medical Director - Mid West Region Lincoln , Nebraska Apply Now 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.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Humana Medical Director - Southeast Region Concord , New Hampshire Apply Now Become a part of our caring community and help us put health first. 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 Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Claims Management Tallahassee , Florida Apply Now 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) Preferred Qualifications.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Claims Management Olympia , Washington Apply Now Become a part of our caring community and help us put health first. Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Humana Medical Director - Northeast Region Salt Lake City , Utah Apply Now Become a part of our caring community and help us put health first. 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.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Become a part of our caring community and help us put health first. 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.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
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 Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Claims Management Providence , Rhode Island Apply Now Become a part of our caring community and help us put health first. Satellite, cellular and microwave connection can be used only if approved by leadership.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
We are recruiting for a Grievance and Appeals Specialist - Denver Health Medical Plan to join our team! Must have a thorough understanding and working knowledge of managed care, health insurance plans, regulatory, and other policies and procedures, including grievance and appeals practices.
$51,098 - $69,133 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Claims Management Montpelier , Vermont Apply Now Become a part of our caring community and help us put health first. 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Oversees coding practices and clinical documentation, grievance, and appeals processes (including pharmacy), and conducts reviews for durable medical equipment (DME), genetic testing, etc.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Provide support to Medicaid markets within the region, aiding in case review, peer to peer and appeals as needed. Provide thought leadership and consulting expertise on population health management approaches and metrics specific to the senior population with a strong lens on intersecting behavioral and social health needs.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Comprehensive understanding and ability to interpret federal and state government (DHCS and CMS) guidelines, and eligibility and enrollment process in order to setup core systems for claims, case management, and grievance and appeals.
ExpandApply NowActive JobUpdated Yesterday
grievance and appeals jobs
FEATURED BLOG POSTS
Is There a Slow Decline of the Labor Market and Wage Growth?
BLS data from January 2023 to March 2023 states that,
2023 Quarterly Review: What’s Happening in Recruitment?
It’s that time again. It’s your quarterly review. Get excited because this is a great time to review some of the amazing accomplishments you and other pros like you have made in recruitment for 2023 thus far! Despite recruitment challenges, things are starting to balance out in the candidate market - partly because of the brilliant ideas and methods being used.
How To Decorate a Cubicle for Inspiration & Productivity
You know the negative reputation cubicles have – dull, dreary, gray. How can you possibly be expected to sit in one every day and be your naturally productive, enthusiastic, and upbeat self? The answer lies in decorating your cubicle so it sparks creativity and feels welcoming. While this might seem impossible given the bland canvas you have to work with, take heart because it’s totally doable!
How do Employers Verify Education?
At any stage in your professional journey, you may come across an employer or a recruiter who asks to verify your educational credentials. This shouldn’t come as a surprise as 30% of candidates admitted to lying on their resumes, yet 79% of them never get caught. In fact, 85% of employers in the US who conduct background checks find that candidates have lied on their resumes or job applications.
How to Ask for a Higher Starting Salary
Maybe you think you’ve finally found your dream job. Everything about it is perfect, except… the salary. Unfortunately, it just isn’t where you want it to be. So, should you give up and move on? Given all the effort you’ve already invested, it’s probably wise to try and negotiate a better salary before you do.
10 Practical and Effective Strategies to Persuade Anyone of Anything
Learning how to persuade people is like a key that can unlock any door. Acing the interview for the job of your dreams. Getting the best deal on a new car. Closing a sale with a skeptical customer. All of these wins require a level of persuasiveness.
Assistant Manager Resume Guide
It can be very challenging for many individuals to find a job in the current economy. As a result, the unemployment rate is only starting to decrease after being at its highest since the Great Depression. One of many reasons this is occurring is because this pandemic has encouraged people to quit their jobs to search for better working conditions, become entrepreneurs, or change careers.