- UpvoteDownvoteShare Job
- Suggest Revision
Provider Services Grievance and Appeals. The Grievance and Appeals (G&A) Customer Service representative will oversee the Gainwell Grievance and Appeals team for our Ohio Department of Medicaid client.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Grievance and Appeals Specialist. Receive, process, categorize and perform initial research on Grievance & Appeals. Insurance Company, Workers Compensation, Disability, HMO or MLTC. Knowledge of appeals and grievances, claims processing or utilization management/case management in a managed care organization required.
$28.38 - $31.93 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The UMQM Nurse shall also participate in Utilization Management related activities with the Appeals and Grievance Department as well as the Compliance Department to assure that the quality compliance is being met for NCQA, state and federal regulatory requirements.
Full-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
As a member of SFHP’s the Grievance Review Committee, the QRN supports the Grievance and Appeals team in ensuring that clinical concerns are addressed as part of grievance investigations.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Document clinical reviews and provides clinical support and guidance to the Grievance and Appeals Team. Review incoming grievance and appeals for clinical quality concerns and expedited status.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD) Coordinates Care for Lower Level of Care coordination such as Skilled Nursing Facility, Home Health, Home Infusion, Rehab, and other community program as appropriate.
ExpandApply NowActive JobUpdated Yesterday - 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 Today - UpvoteDownvoteShare Job
- Suggest Revision
Responsible for formulating/implementing and executing all processes, requests, workflow, or policies as requested by management in a courteous and efficient manner, including offering a proactive approach to suggestions and recommendations and working or cooperating with Appeals and Grievance Manager or managed effectively.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Forwards copy of Explanation of Benefits to appropriate personnel, underpay explanation of benefits to Appeals Coordinator or Collector, Overpayment to Refund Analyst and secondary payment request to Billing Coordinator.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Summary We are seeking a talented individual for a Nurse Reviewer Appeals and Hearing to coordinate and perform all appeal-related duties including analyzing and responding appropriately to appeals from providers; reviewing documentation to ensure all aspects of the appeal have been addressed properly and accurately; preparing case files and case summaries for hearings; and participate in virtual and on-site hearings.
RemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Oengaging and retaining talented faculty to fulfill the needs of the Department and those of the SOM.omonitoring and responding to engagement surveys and exit reports; andocounseling, grievance, and appeals processes.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Assistant Prosecutors in the Child Support Unit represent the local child support enforcement agency in civil matters involving paternity, child support establishment, and modification and enforcement before the Cuyahoga Common Pleas Court, Divisions of Domestic Relations and Juvenile, and Courts of Appeals.
$77,580 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Amentum is seeking a Paralegal to assist with the USCIS litigation support team on Visa Petition Appeals Records of Proceeding (ROP) and E-ROPs. Under close guidance and supervision, the paralegal will follow decision-tree-like guidance to match case files to help ensure case files are have complete, accurate and timely documentation including decisions, appeals processes, etc.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol. Maintain working knowledge of COA and OHP benefits including physical health and behavioral health (RNCC/AI AN will maintain working knowledge of Native American Oregon Health Plan Fee For Service program benefits.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
In addition to transplant care, Methodist Hospital Specialty and Transplant is a full service hospital with over 260 beds that provides specialized services for liver cancer care, emergency care, weight loss surgery, urology surgery, vascular surgery, inpatient rehabilitation, colorectal surgery and behavioral health care.
ExpandApply NowActive JobUpdated Today
grievance and appeals jobs Title: health Company: Association For Community Affiliated Plans
FEATURED BLOG POSTS
Recruiting in a Recession: Hard Truths That Talent Acquisition Experts Must Accept
The summer had economists from around the globe embroiled in a debate about a possible recession coming in the next few years (or months). As of October 2022, the U.S. Labor Department data put the current inflation rate at 7.7%. The recent layoffs in the tech industry are just the first of what is soon to be a string of cutbacks by companies looking to save costs. For recruiters, this means freezes in hiring and fewer openings. It will also include the uphill task of finding the best candidates for them from the coming influx of recently laid-off job seekers. Now is probably a good time to brace for tough times in the next few years in the talent acquisition industry. To survive and thrive recruiting in a recession, here are some hard truths you will need to accept.
10 Importancies of Setting Realistic Goals
We’ve all heard how important it is to set professional and personal goals. Developing and establishing goals keeps us motivated and moving forward in life. But not all goals are created equal. If you’re chasing goals that are too lofty, you’ll end up disappointed when you cannot reach them. Setting goals that are achievable and measurable is the key to success.
Email Etiquette Principles - Why is it Important
Why is email etiquette important? Let's imagine you're hiring for a new role, and you’ve just received the email below.
10 Reasons HR is Important to an Organization
"Nothing we do is more important than hiring and developing people."
7 Importances of Organizational Culture and How to Build It
The world of work has drastically changed in the past few years. Where a good salary and a nice office might have been enough to attract talent in the past, employees today expect flexibility, growth opportunities, and a healthy work environment. In fact, 77% of applicants say they’d consider a company’s culture before applying for a job.
Collaborative Recruiting: The Key to a Better Talent Acquisition Strategy
Talent acquisition is a multi-stage process where candidates undergo various application steps before getting hired. The unfortunate reality is that it is a labor-intense system, with the hiring manager and recruiter often handling all of the work on their own. Ask any one of them, and you will hear about the overabundance of applications and the demanding task of filtering through them to find the best candidates. The quality of talent suffers under the weight of all that work on one person's hands. It's not easy, but as many companies are starting to realize, there is a better way. The future of talent acquisition lies in collaborative recruiting!
4 Talent Acquisition Trends Going Into 2023
For better or worse, a side effect of the COVID-19 pandemic was a marked shift in talent acquisition practices worldwide. With the struggle to retain talent that began in 2020, companies have had to rethink recruitment strategies. The result has been new talent acquisition trends that are well on their way to becoming commonplace. These are the practices that are going to become even more widespread going into 2023.