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The Medical Director coordinates care with the County Mental Health Plans that are responsible for the care of the population with a Serious Mental Illness (SMI), the County Alcohol and Drug Program, as well as all IEHP community and provider partners.
$115.71 - $159.1 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Grievance Coordinator is r esponsible for responding to grievances related to medical, psychiatry, psychology, dental, and any other contracted healthcare services in accordance with MODOC policy.
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Assist members who have filed appeals or grievances to access care by assisting with prior authorizations, securing appointments, obtaining durable medical equipment, medications, transportation and other services as needed to resolve the grievance/appeal.
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The Vice President (VP) of Business Operations is responsible for providing strategic direction, business planning and execution, and overall executive leadership for claims processing, enrollment and billing operations, payment integrity, grievance and appeals and CMS compliance readiness across all customer segments within the company.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Ensure that the proper payment guidelines are applied to each claim by using the appropriate tools, processes, and procedures (e.g., claims processing policies & procedures, grievance procedures, state mandates, CMS/Medicare/Medicaid guidelines, benefit plans, etc.
$50,000 - $56,000 a yearFull-timeExpandUpdated 1 month ago - UpvoteDownvoteShare Job
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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. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion.
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Responsible for identification of significant events for follow-up; assist in managing the “good catch” program; generate safety reports for Risk Director; attend safety briefing meetings for Risk Management; assist with grievance resolution where patient safety issues are involved; assist with investigation of alleged abuse by healthcare provider; assist with threat assessment and/or workplace violence issues.
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Handles patient and visitor issues and complaints utilizing the grievance policy and procedure. Utilizes surge protocol as needed or when requested by Provider. Supervises the orientation, training and cross training of clinic staff to ensure that all competencies, policies, established practices and standards are followed and adhered to in partnership with the Multi-Site Manager and ProviderCommunicates job expectations and conducts individual and group coaching and training interventions for new and tenured clinic employeesCollaborates with the Provider to facilitate daily briefing and monthly meetings.
Starting at $20 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider),grievance and appeals (member/provider) via target system. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider),grievance and appeals (member/provider) via target system.
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Assist the Appeals & Grievance Coordinators, Pharmacists, Medical Directors and Quality Improvement Coordinators with processing pharmacy benefit appeals and grievances. Under the supervision of a pharmacist and/or the operations supervisor, assist with pharmacy benefit projects including, but not limited to process improvements, cost saving initiative projects, benefit implementation/changes, and member/provider/pharmacy outreach.
$45,850 - $55,500 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Review and evaluate appeals and grievance requests to identify and classify member and provider appeals, hand-off to appropriate department for provider and clinical appeals; process member and provider complaints as appropriate to meet the CMS, State and Accreditation requirements.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Contact outpatient provider(s), school and other stakeholders to discuss aftercare to ensure proper handoff. Serve as patient advocate when a patient has a grievance, following the System policy and procedure.
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Software to ensure that any audit, follow-up communication, grievance or appeal can be handled in. The Member Services Specialist assists members telephonically with issues involving enrollment, transportation, benefit questions, coverage limits, payments, claims, and those matters that involve provider networks.
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Liaison to Services team coordinating efficient and accurate member ad provider servicing as well as Grievance and Appeals processing according to CMS requirements and regulations. Liaison to Services team coordinating efficient and accurate member ad provider servicing as well as Grievance and Appeals processing according to CMS requirements and regulations.
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Merakey is a non-profit provider of developmental, behavioral health, and education services. Holds supervisors accountable for handling bargaining unit fact finding and grievance related to violations such as attendance and performance.
ExpandApply NowActive JobUpdated 5 days ago
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