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Appeals and Grievance Nurse Registered Nurse - Tyler Apply Now Chat with Eve. The Clinical Appeals Nurse will review each case identified/referred for appeal based on Milliman Care Guidelines (MCG), InterQual, and/or other relevant guidelines, determined the viability of the appeal, and manage the appeal process.
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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.
$52.56 - $64.25 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required.
$93,400 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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1 year of experience in any of the following areas: Grievances and Appeals, Claims, Regulatory Compliance, Customer Service, or related fields required. The incumbent collaborates with internal departments such as Customer Service, Provider Operations, Pharmacy, and Medical Management to identify factors necessary for the optimal resolution of Grievances and Appeals.
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Directly responsible for supervising, directing, and supporting staff of Customer Service Representatives in the Call Center. Handle customer issues and appeals related to customer satisfaction, meter reading, payment processing, collection and billing.
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The nature of work includes customer service, responding to difficult situations, and performing plan review that requires sitting for prolonged periods of time under normal office conditions.
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Familiar with grievance and appeals process. Must demonstrate excellent phone etiquette and exceptional customer service skills. The successful candidate should be able to demonstrate previous successful/positive customer service encounters or programs.
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As needed, perform reviews on utilization review, appeals and grievance cases. EO/AA Responsibilities Job Specific Responsibilities and AccountabilitiesProvide strategic oversight for development and management of policies, procedures, and clinical programs to improve clinical and service quality, reduce healthcare costs and meet other desired business outcomes.
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Areas of oversight for this position include, but are not limited to, case management, quality management, utilization management (UM), and grievance and appeals and committee participation.
$115.71 - $159.1 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Education PreferredBachelor's DegreeExperience Required:At least 0-2 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services and /or public services or public benefits programs with claims and Medicare experience.
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Participates in processes related to faculty counseling, faculty grievance, and appeals related to the SON operations. Through research, teaching, service, and outreach, UConn embraces diversity and cultivates leadership, integrity, and engaged citizenship in its students, faculty, staff, and alumni.
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In addition to competitive pay and our exceptionally positive culture , we offer our Call Center Supervisor / Pest Control Customer Service Manager the following benefits: Full health insurance Paid time off (PTO) Paid training Additionally, we are proud of our: Upbeat work environment Fun co-workers Incredibly supportive management Don't let us forget we provide free coffee and snacks to keep you fueled.
$50,000 - $65,000 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Case types include Adoption, Civil, Criminal, Family Law, Guardianship/Conservatorship, Juvenile Delinquency, Juvenile Dependency, Juvenile Emancipation, Lower Court Appeals, Mental Health, Probate, Protective Orders and Severance cases.
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The Sales & Marketing Director must be self-motivated, organized and professional. Be available on call as required as per regulatory standard or have a qualified alternate delegating nurse available on call.
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The ideal candidate will have clerked for the US Fifth Circuit Court of Appeals or the Louisiana Supreme Court. Senior Labor and Employment attorney - New Orleans, 7+ years of experience in labor and employment or complex commercial litigation.
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call service grievance and appeals jobs Title: customer service Company: Cvs Health
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