Position Summary: The Appeals & Grievances Clinical Specialist is responsible for receiving, investigating and responding verbally and in writing to member and provider clinical appeals and grievances. Duties and Responsibilities: Ensures that appeals and grievances are properly classified (e.g.
Become a part of our caring community The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal or further request is warranted
JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers
At Curana Health, were on a mission to radically improve the health, happiness, and dignity of older adults—and were looking for passionate people to help us do it. As a national leader in value-based care, we
The Manager, Clinical Appeals & Grievances is responsible for leading, operating, and advising a dynamic and fast-paced Clinical Appeals & Grievances team. This role works closely with multiple leaders in the organization to identify priority focus areas for
Appeals And Grievances Medical Director At UnitedHealthcare, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.
Appeals And Grievances Medical Director At UnitedHealthcare, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.
Appeals And Grievances Medical Director At UnitedHealthcare, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.
Appeals And Grievances Medical Director At UnitedHealthcare, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.
Claims Support Specialist Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for
Job Title Responsible for utilizing clinical acumen and managed care expertise related to researching, resolving and responding to requests for member and provider appeals, grievances, reconsiderations and corrected claims for all lines of business with emphasis on
SUMMARY: Contribute to the professional standing and profitability of the company by supplying customers with outstanding service and results, as well as meeting the performance standards of this role. These are achieved by consistently recruiting, pro-actively
With a career at The Home Depot, you can be yourself and also be part of something bigger.Position Purpose: The Pro Sales Manager (PSM) is responsible for leading a team of Pro Account Representatives to drive
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the members health needs while promoting quality cost effective outcomes.
Job DetailsJob Location: Western Region - CA 92782Position Type: Full TimeJob Category: DentalAbout the RoleLIBERTY Dental Plan is seeking a highly experienced and collaborative Senior Staff Dentist to provide clinical leadership across our Utilization Management (UM)
About us: Foodsmart is the leading Foodcare platform in the U.S., built to deliver nutrition-driven healthcare at scale. Powered by a national network of Registered Dietitians, Foodsmart combines personalized clinical nutrition care, behavior change tools, and
SUMMARY: Contribute to the professional standing and profitability of the company by supplying customers with outstanding service and results, as well as meeting the performance standards of this role. These are achieved by consistently recruiting, pro-actively
Position Summary: Foster productive relationships between the Company, outside Union contacts, and employees within the organization. Negotiating, interpret, and administer labor contracts, resolve disputes, and ensure compliance with labor laws and regulations. Support and develop an
Overview *Please include a cover letter for further consideration* The Graduate Medical Education (GME) Program Coordinator partners and collaborates with the program director and leadership on all aspects of GME program management, including the operational and
At the Metropolitan Water District of Southern California, we deliver reliable water to a region with 19 million people—and to accomplish this, we rely on a team of talented employees: innovators, problem-solvers, and collaborators who make