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.
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
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.
Member C&G Coordinator I UPMC Health Plan is hiring a full-time Member C&G Coordinator I in the Member C&G department. This position works Monday through Friday, daylight hours and will be a remote position. The Member
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
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
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
OverviewCotiviti works with more than 200 healthcare payers and health systems, including all of the top 25 plans in the United States, to deliver higher-performing payment accuracy, risk adjustment, quality improvement, and consumer engagement programs. We
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
Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the