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7 years or more years of equivalent work experience in Grievance and Appeals, Claims, Authorizations, CMS, Provider Disputes and/or healthcare industry. The Grievance and Appeals Manager possesses strong leadership skills, in-depth knowledge of Medicare and Medicaid regulations, and has a commitment to delivering exceptional service to our members.
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Job Description :A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
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Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Our Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations.
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Reviews and analyzes Revenue Agent, Appeals Officer, and Counsel Attorney instructions, reports, case files and support statements, and interprets tax law court decisions, and legal opinions to determine and prepare accurate computations for the most demanding and complex Appeals cases.
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Apply CareSource Medical Policy and Milliman guidelines when processing clinical appeals. The Clinical Appeals Nurse is responsible for the completion of clinical appeals and state hearings from all states.
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Provides first-level engineering design functions.
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Elevance Health operates in a Hybrid Workforce Strategy. The health of our associates and communities is a top priority for Elevance Health. At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.
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