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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. denial of service, denial of payment, or a grievance about a provider)
* Processes appeals...

Company :
Highmark Health
Job Description :
JOB SUMMARY
This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical interven...

Company :
Highmark Health
Job Description :
JOB SUMMARY
This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical interven...

Pay Transparency:
The pay range for this role is:
$85,000.00-$160,000.00/Annual
The base pay actually offered to the successful candidate will take into account, without limitation, the candidate's location, education, job-knowledge, skills, and experience in prior relevant roles.
Incentives may also be provided as part of Haemonetics' employee compensation. For sales roles, employees will be e...

Position Summary:
The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. A&G works in collaboration with divisions within and outside the organization to resolve issues in a timely and compliant manner.
The A&G Clinical Spe...

Position Summary:
The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. A&G works in collaboration with divisions within and outside the organization to resolve issues in a timely and compliant manner.
The A&G Clinical Spe...

Job Type
Full-time
Description
Join the team shaping the future of healthcare! Medbridge is a dynamic software-as-a-service company working with the country's largest healthcare providers to build technology solutions that help patients get better faster while decreasing the overall cost of care. Our Marketing team is growing, and we're looking for a part-time SEO and AI Content Specialist to ...

ROLE SUMMARY
Everything we do, every day, is in line with an unwavering commitment to the quality and the delivery of safe and effective products to patients. Our science and risk-based compliant quality culture is innovative and customer oriented. Whether you are involved in manufacturing, testing, or compliance, your contribution will directly impact patients.
All over the world, Pfizer colle...

ROLE SUMMARY
Everything we do, every day, is in line with an unwavering commitment to the quality and the delivery of safe and effective products to patients. Our science and risk-based compliant quality culture is innovative and customer oriented. Whether you are involved in manufacturing, testing, or compliance, your contribution will directly impact patients.
All over the world, Pfizer colle...

ROLE SUMMARY
Everything we do, every day, is in line with an unwavering commitment to the quality and the delivery of safe and effective products to patients. Our science and risk-based compliant quality culture is innovative and customer oriented. Whether you are involved in manufacturing, testing, or compliance, your contribution will directly impact patients.
All over the world, Pfizer colle...