Purpose The Senior Manager of Clinical Appeals is responsible for leading the clinical appeals management team... with internal and external stakeholders to resolve complex appeal cases. Reports to Director of Clinical Appeals Essential...
, in a consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases... Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting the Appeal and Grievances...
outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure... clinical judgement and independent analysis, collaborating with members and those involved with members' care including...
and those involved with members care including clinical nurses and treating MDs. The Case Management Nurse, Senior will report to the... and case management (CM) activities demonstrating clinical judgment and independent analysis, collaborating with members...
' care including clinical nurses and treating physicians. The Triage Registered Nurse Case Manager will report to the FEP...) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members...
as needed. Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager..., and oversees the health care needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its...
Post Service Clinical Review nurse will report to the manager of FEP Post Services. In this role you will be reviewing...) department is BSC Federal Employee Program (FEP) retrospective clinical review program that entails detailed claims review...
Application Manager II reports to the Senior Manager Information Technology I.T. Solutions Delivery. This role acts as the... Services Domain experience required. 3 years of Clinical Care and 3 years of HIE, HEDIS experience preferred. Functional...
for qualified applicants with disabilities who self-disclose by contacting the Senior Human Resources Manager. Applicants may... components including documentation of all DPRC policies and procedures. • Responds to student accommodation determination appeals...
for qualified applicants with disabilities who self-disclose by contacting the Senior Human Resources Manager. Applicants may... components including documentation of all DPRC policies and procedures. • Responds to student accommodation determination appeals...
as needed. Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager.... Serves as a medical manager and policy advisor to SHP and its Chief Medical Officer. Is accountable for and provides...