Director of Clinical Appeals & Grievances
Healthfirst
Healthfirst is seeking a Manager, Clinical Appeals & Grievances to lead and optimize a dynamic team, coordinating with multiple leaders to standardize processes and improve performance. The role oversees internal and external production teams to ensure high quality and regulatory compliance. The ideal candidate has RN credentials, a Bachelor's degree, and experience in utilization management or appeals processing, with proven leadership in a fast-paced environment. #J-18808-Ljbffr Healthfirst
$103.4k - $149.43k
The Manager, Clinical Appeals & Grievances is responsible for leading, operating, and advising a dynamic and fast-paced Clinical Appeals & Grievances... ...in the preparation of case preparation for Medical Director Review ensuring that all pertinent information (i.e. case...SuggestedContract workTemporary workWork experience placementLocal areaFlexible hours$227.6k
...performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically... .... Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales...SuggestedFor contractorsPrivate practiceWork at officeLocal area- Overview Director of Clinical Operations Lead the Future of Senior Care to cover our Midwest Nursing Homes - Chanute, Council Grove, Haysville... ...to Social Services in areas such as event management, grievance response, guardianship, and advance directives. Collaborate...SuggestedTemporary workRelocation package
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...Remote Full time R11844 Job Summary In collaboration with the Senior Director of Clinical Management, the Director is responsible for the operational strategy and management of Otsuka clinical programs, including coordination with other relevant parties (e....SuggestedFull timeContract workTemporary workLocal areaRemote workWorldwideFlexible hours- ...underpayment root causes by contacting payers via phone and through review of client systems and account documentation Submit written appeals detailing expected reimbursement and clearly outlining reasons for additional payment, including citation of contract language,...SuggestedContract work
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$105k - $115k
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...Commercialization, Inc. (OPDC) a U.S.A. subsidiary exists the Global Clinical Development (GCD) department. OPDC-GCD are a group of... ...payors). Detailed Description of Duties: Otsuka is seeking a Director, Global Clinical Development who will be responsible for the...Full timeTemporary workLocal areaRemote workWorldwideFlexible hoursWeekend work- Revance is seeking an Associate Director, Clinical Development to support strategy and execution of Phase 1-3 trials across therapeutic indications. You will collaborate with the VP of Clinical Development and Data Science to design studies, develop protocols, and prepare...
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- .... Responds to inquiries and administrative problems brought to Executive Leadership by VISN staff, subordinate VAMCs/Outpatient Clinics, officials of VA Headquarters, Congressional Offices, Veterans Service Organizations other Federal Agencies and other governmental...
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- Health System Specialist Health System Specialist will serve as the Executive Assistant to the Chief Nursing Officer for the Veterans Integrated Service Network (VISN) 9 within the Veterans Health Administration (VHA) and provides assistance in policy development and...
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...Job Description Responsible for driving the client through the design of clinical and business processes, solution and technology workflow, and successful adoption that will lead to achieved value. Manage ongoing relationships with clients, providing account management...Temporary workFlexible hours- HealthTrust Performance Group is seeking a Value Analysis Director to lead enterprise value analysis and clinical resource management across IDNs and health systems. The role partners with executive leadership, physicians, and supply chain leaders to drive cost, quality...
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- Director of Clinical Operations 487 - HQ - Chattanooga, TN 37402; 930 - GWTN - Georgetown, SC 29440 Overview Position Type: Full Time Job Shift: Day Category: Health Care Description One to One Health is looking for a Director of Clinical Ops to join our team! Under...Full timeTemporary workWork at officeImmediate startShift work
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- Pennant Group, Inc. is seeking a Director of Clinical Excellence to lead clinical operations across home health and hospice affiliates in Tennessee, collaborating with senior leadership to drive quality, compliance, and performance improvements. This full-time role requires...Full time
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