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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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The Program Manager leads and manages key operational programs, initiatives and strategic projects that span across the functional teams of Claims, Configuration and Appeals and Grievances.
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Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials.
Starting at $14.76 - $31.97 an hour depends on education, experienceFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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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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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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Preferred Skills, Capabilities, and Experiences: Board certification in Pain Management strongly preferred. Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ In 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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Provides guidance on risks that may impact the appeals and grievance operations. Manages appeals and grievance process in accordance with the organization's policies and procedures.
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Along with the Assistant Director, Medicare Advantage Operations, the Program Manager is responsible for program management activities impacting the functional areas within the span of control of the Assistant Director including but not limited to initiation, planning, development, and monitoring of program implementations and day to day operations performance monitoring in order to ensure timeliness and compliance.
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They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
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Minimum Requirements: Requires an MD and Board certification in a medical specialty required. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
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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.
$22 - $33.01 an hourFull-timeExpandApply NowActive JobUpdated 25 days ago - UpvoteDownvoteShare Job
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The health of our associates and communities is a top priority for Elevance Health. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week.
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Assist in the development of internal physician advisors and provide support in developing solutions for complex cases, in the authorization and denial of services, and in the grievance and appeals process.
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The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance process that meets state, federal, accreditation and other regulatory requirements.
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grievance and appeals jobs
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