- LA Care Health Plan (Los Angeles, CA)
- …others. Supervision of the Clinical Services unit and general operations within Appeals and Grievances. Maintain a team of top talent, providing a culture ... Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the...Lead , participate and provide representation of the A&G Team at Internal and External meetings/ workgroups and acts… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... the safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing… more
- Trinity Health (Farmington Hills, MI)
- …NPR) of a Patient Business Services (PBS) center. Serves as part of a team of clinical payment resolution colleagues at an assigned PBS location responsible ... and determining root causes of clinical denials. Responsible for leveraging clinical knowledge and standard procedures to track appeals through first,… more
- Elevance Health (Norfolk, VA)
- …you a check, or ask you for payment as part of consideration for employment. **Grievance/ Appeals Analyst I** + Job Family: CLM > Claims Support + Type: Full time + ... **Location:** + VA, Norfolk + KY, Lexington **Description** **Title: Grievance/ Appeals Analyst I** **Location:** This position will work a...HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of… more
- Elevance Health (Walnut Creek, CA)
- …matter expert for appeals /grievances/quality of care issues and is a resource for clinical and non clinical team members in expediting the resolution of ... for payment as part of consideration for employment. **Nurse Appeals CA (US)** + Job Family: MED > Licensed...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Kepro (Indianapolis, IN)
- …ensure timely and complaint processing. They will be a crucial resource for the Appeals Team , contribute to quality initiatives, and champion continuous care for ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...Appeals Nurse - LPN/RN to join our growing team . Job Summary: Our Utilization Management Appeals … more
- LA Care Health Plan (Los Angeles, CA)
- …in a consistent and accurate manner. This position will focus on quality review of non- clinical grievance and appeals cases for all line of business (LOB) to ... Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job...executing, tracking, and assessing targeted and random audits for non- clinical grievance and appeal case documentation. Ensure A&G Non-… more
- Trinity Health (Farmington Hills, MI)
- …practices, and decisions. Performs daily activities as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned ... of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of the Payment Resolution... denials). Serves as part of the Payment Resolution team at an assigned PBS location responsible for ensuring… more
- Glens Falls Hospital (Glens Falls, NY)
- …MCC's and CC's for reimbursement. In collaboration with Hospital External Review Team (HERT) members, coordinates reviews and responds to internal and external ... but with emphasis on Inpatient Coding. Collaborates with Professional Coders, Clinical Document Improvement Specialists, "Scrubber" Edit Specialists and Providers to… more
- Catholic Health Services (Melville, NY)
- …time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! ... an operations' liaison, collaborating with various entities including payers, clinical , financial and/or operational departments. Duties/Responsibilities: Conducts data analysis… more
- State of Colorado (CO)
- Clinical Pharmacy & FQHC Policy Specialist Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4466251) Apply Clinical Pharmacy & FQHC Policy ... to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs . https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs We are looking for a Clinical Pharmacy & FQHC Policy Specialist for the Benefit… more
- Kepro (Greenville, NC)
- …a vital partner for health solutions in the public sector. Acentra Health seeks a Clinical Assessor to join our growing team . Job Summary: Acentra Health is ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra… more
- Elevance Health (Woodland Hills, CA)
- …ask you for payment as part of consideration for employment. **RVP Sr Clinical Officer-Commercial CA.** + Job Family: MED > Licensed Physician/Doctor/Dentist + Type: ... WOODLAND HILLS + CA, SAN FRANCISCO **Description** **RVP II Sr Clinical Officer (Commercial)- California** **Location:** **California** **Summary** In this role as… more
- LA Care Health Plan (Los Angeles, CA)
- …Develop and maintain Stars work plan, convene committees and workgroups, and assist Stars Lead and Stars Core Team by leveraging technology and tools to ... Clinical Quality Program Manager II (CAHPS) Job Category:...satisfaction for LAC members. Work closely with Stars Core Team (Stars Lead and Manager Stars Analytics)… more
- CommonSpirit Health Mountain Region (Westminster, CO)
- …serving some of the most diverse communities across the nation, letting humankindness lead the way. Overview: **RN Clinical Coordinators may be eligible for ... and leaders who care about your success. Join our team as a Registered Nurse (RN) Clinical ...excellent patient-centered care with teamwork and compassion. Our department appeals to anyone interested in furthering their skillset, specifically… more
- State of Colorado (Golden, CO)
- Social Worker/Counselor IV (Behavioral Health Lead ) - Summit YSC in Golden Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4463953) Apply ... Social Worker/Counselor IV (Behavioral Health Lead ) - Summit YSC in Golden Salary $82,572.00 -...the Position: This position exists to provide behavioral health clinical services to committed and detained youth in the… more
- HCA Healthcare (Austin, TX)
- …Eligibility for benefits may vary by location._** We are seeking a Hospice Director of Clinical Services for our team to be an innovator. HCA Healthcare partners ... **Description** **Introduction** We are seeking a Hospice Director of Clinical Services with St. David's Hospice & Family Care...appeals and denials as requested. + Provides a lead role regarding oversight and approval of effective workflow… more
- American Red Cross (Stockton, CA)
- …in association with other Red Cross networks, throughout the world. When you join our team , you have a direct impact on a meaningful mission, and you can help save ... with a focus on building allyship and a culture of belonging that empowers all team members. Come to learn, grow, and succeed while sharing your passion for making a… more
- American Red Cross (Oakland, CA)
- …in association with other Red Cross networks, throughout the world. When you join our team , you have a direct impact on a meaningful mission, and you can help save ... with a focus on building allyship and a culture of belonging that empowers all team members. Come to learn, grow, and succeed while sharing your passion for making a… more
- CVS Health (Harrisburg, PA)
- …health care more personal, convenient and affordable. Position Summary The Lead Director of Value-based Contracting manages and oversees Value-based operation in ... compliance, and financial goals and cost initiatives. + Works with Practice Transformation Team , VBS reporting team and other key internal teams to develop… more