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Provide direct support to the Quality Review nursesProvide after hours and weekend coverage on a rotational basis to support 24/7 appeals work. Medical Management - Medicare Complaints, Grievance & Appeals experience.
$374,900Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Collects Inmate Informal Resolution Compliant (INF), Inmate Formal Grievance (FG), Warden’s Administrative Remedy (WAR), or Appeals forms from each housing unit’s IGP box each business day (excluding Saturdays, Sundays, and legal holidays.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Paralegals assist with the University’s responses to internal and external information requests, such as Public Information Act (PIA) requests; subpoenas or court/legal/administrative orders; Employee Grievance Hearings; Public Safety Denial of Access Appeals; and similar matters handled by OGC. As the need arises, Paralegals may be assigned primary responsibility for such matters.
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Immediate need for a talented Grievance and Appeals Coordinator 1. Must have previous Grievance and Appeals exp Analytical and research savvy, good writing skills Strong organization and able to multi-task Must have at least 1 year of recent healthcare experience and strong work history.
Part-timeRemoteExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Conducts intake/triage and appropriate classification of Clinical A&G, and Pharmacy requests and makes accurate judgment on appeal, grievance, Provider Claim Disputes, medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the department.
$55 an hourRemoteExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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An aspect of the role includes an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.
$274,400 a yearFull-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol. Preference may be given for current Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), or Licensed Marriage and Family Therapist (LMFT.
$97,080 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Position is fully remote and will be supporting dental grievance and appeals cases. May coordinate the Grievance and Appeals Committee. 2+ years grievance or appeals, claims or related managed care experience.
Full-timeExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Provide advice and implement management decisions related to disciplinary measures; provide Administration responses to Board of Appeals or Grievance Panel filings, liaising with the Legal Counsel (LEG), the Ethics Program Officer, and/or the Ombudsman, as appropriate.
$180,451 a yearFull-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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Requires a BA/BS and minimum of 2 years related experience preferably in healthcare insurance departments such as Grievance and Appeals, Contracting or Claim Operations, law enforcement; or any combination of education and experience, which would provide an equivalent background.
$100,878 a yearFull-timeExpandApply NowActive JobUpdated 13 days ago - UpvoteDownvoteShare Job
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Provide advice and implement management decisions related to disciplinary measures; provide Administration responses to Board of Appeals or Grievance Panel filings, liaising with the Legal Counsel, the Ethics Program Officer, and/or the Ombudsman.
Full-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Supervise the Grievance and Appeals team to ensure appropriate handling of member appeals and grievances. This position manages the day-to-day operations of the Appeals and Grievances operations for our Medicaid Health Plan - HSCSN. Assures that the department is compliant with all regulatory requirements, manages turnaround times, submit reports to the executive leadership team, develops strategies to improve processes.
$156,603.2 a yearFull-timeExpandUpdated Today - UpvoteDownvoteShare Job
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Description: This position manages the day-to-day operations of the Appeals and Grievances operations for our Medicaid Health Plan - HSCSN. Assures that the department is compliant with all regulatory requirements, manages turnaround times, submits reports to the executive leadership team, and develops strategies to improve processes.
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Previous grievance and appeals experience. The Grievances & Appeals Representative 2 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties.
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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.
$274,400 a yearFull-timeExpandUpdated 13 days ago
grievance appeals and jobs in Washington, DC
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