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Manage assigned member appeals and grievance cases from documentation, to investigation, and through resolution, ensuring the final disposition of a member's appeal or grievance is compliant with the regulatory requirements set-forth by NCQA, DOI, CMS, DOL and any state or federal specific regulations that apply.
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Regularly communicates with the UM Manager, Medical Director, physician advisor/reviewer and primary care physician for support, problem resolution and notification of decertification and appeals.
$33.86 - $52.48 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Creating scalable processes and mechanisms that sync with other internal support teams (e.g., customer support, seller support, account managers) to ingest, assign and initiate investigations (and appeals) quickly without sacrificing quality.
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Pacifica was founded in 2011 and has grown to include over 60 experienced attorneys and professional support staff who work in the areas of municipal finance, public-private partnerships, litigation, appeals, public records, ethics, complex transactions, real estate, procurement, construction, school law and other areas of general municipal law for public and private sector clients.
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As a member of the Regulatory, Compliance, & Contracts Team, the Regulatory Coordinator processes appeals, complaints, and grievances under the direction of the Regulatory Supervisor This role will analyze, research, and make determinations (decisions) on exception requests, Office of the Insurance Commissioner inquiries (complaints), grievances, and appeals on the member's behalf, as a well as manage and present relevant information to our formal Appeal's Committee.
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Payer Formularies and restrictive Utilization Management Criteria including: Prior Authorization Processes, Step Edits, Appeals, detailed Clinical Documentation, Peer to Peer reviews etc. Field Reimbursement Manager, Immunology Position Summary: The Field Access & Reimbursement environment for specialty biologics has proven to be highly challenging for HCPs and Patients.
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Follows Medicare guidelines regarding patient choice, admit/discharge notifications, and appeals. Facilitates arrangement of post-acute care services. Teladoc® Allied health plan members (and their dependents – even if not covered under your Allied health plan)can access free sick or acute care consults with board-certified physicians 24/7.
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5+ years of experience in content and script writing that appeals to wide audiences. Develop concepts, storyboards, and write script content for various types of videos (explainer, promo, and interview style videos.
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Representing the State in appellate matters before the Court of Appeals and Washington Supreme Court. CRJ prosecutes all manner of crime such as homicide cases in smaller counties, sexual assault cases, child predatory cases, public corruption and police accountability cases, and white-collar crimes such as tax fraud, general fraud, organized retail crime and wage theft.
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Provides technical guidance, information, and assistance for a variety of Employee Relations programs such as disciplinary actions, grievances, appeals, complaints, and drug testing. Assists the Specialist with the preparation of agency files for third-party appeals, including Merit Systems Protection Board appeals and Equal Employment Opportunity document requests and hearing files.
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Audience Engagement: Craft content that appeals to, engages, and nurtures our diverse clientele - from sales novices to seasoned professionals. As a Content Writer at SalesLight, you’ll be instrumental in crafting compelling content that resonates with our audience and underscores our position as a premier sales mentorship and coaching provider.
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Strong candidates will have hands-on experience in all phases of litigation including law and motion, depositions, trial and appeals and should be proficient in oral and written advocacy. Murphy, Pearson, Bradley & Feeney (MPBF) is currently seeking an experienced Litigation Associate to join our Seattle office.
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Work collaboratively with the Fund Development Department on the Gala & Auction and other projects as needed, including fundraising appeals and thank you letters. LIHI is a national leader in sponsoring tiny house villages as a crisis solution to homelessness.
$65,500 - $75,000 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Oversee unemployment claims, appeals, subpoenas and disputes. This position will work closely with the Director of Employee Relations, VP of Human Resources and the management team in implementing strategic HR direction for these locations.
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Acts as a brand ambassador and reflects the company values; partners with the store leadership team on the creation of an engaging experience that appeals to the FP customer. Collaborateswith key partners to effectively execute shipment processing, restocking, and placement of product while maintaining FP's visual and display standards; ensures omni-channel orders are processed timely and accurately.
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appeals job in Seattle, WA
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