Clinical Appeals Ops Lead: Determinations & Expedited
Jobtailor
Jobtailor in Connecticut seeks an Appeals Processor to handle daily Commercial Member Clinical Appeals (CMCA), draft determination letters, and intake expedited requests with accuracy. You will collaborate with Medical Directors, Nurses, and Providers, triage faxes, update systems, and move cases through the Complaints and Appeals Tracking System (CATS) while upholding regulatory timelines. #J-18808-Ljbffr Jobtailor
Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Clinical Appeals Ops Lead: Determinations & Expedited in Hartford, CT vacancy
- ...t just our job - it’s our passion. As a leading children’s health system experiencing steady... ...Job Description The Team Lead for the Clinical Social Work is responsible for the day-... ...to team for Manager (frequency to be determined) Team Communication (emails, newsletter...SuggestedWork experience placementWork at officeLocal areaShift work
- ...and other common practices across the system. Position Summary Reporting to the Director of Quality and Clinical Integration, the Risk Adjustment Program Team Lead serves as a coordinator and resource for the Risk Adjustment team; works with other coders to ensure that...SuggestedWork experience placementWork at office
- Aetna, a CVS Health Company, is seeking a Medical Director to lead Medicare Part C appeals and oversee the appeals process. This remote role spans the US and requires an active medical license and board-certified specialty. You will supervise appeal nurses, participate...SuggestedRemote job
- A community service organization in Hartford, Connecticut, is seeking a Clinical Supervisor to provide therapy and supervision for children and families. The role involves direct service provision, clinical oversight, and participation in programmatic initiatives. Candidates...Suggested
- PsychPlus seeks a licensed Therapy Clinical Director for Connecticut, blending direct patient care with clinical leadership. The role starts remotely as the clinic is established, then shifts to in-person or hybrid work at the new location, with a 70/30 clinical to administrative...SuggestedRemote jobShift work
- Yale University seeks a licensed optometrist to serve as Program Manager of Optometry, overseeing daily clinical and operational functions within the Division of Optometry in the Department of Ophthalmology & Visual Science. The role focuses on patient care, care coordination...
- Connecticut Children’s Medical Center is seeking a Medical Assistant Lead in Cardiology at our Hartford, CT site. The role is a full-time,... ...(15%). The ideal candidate has at least 3 years as an MA or clinical lead, BLS/CPR, and MA training. You will supervise daily...Full time
- Mohegan PA in Uncasville, Connecticut is seeking a Cashiering Operations Supervisor to oversee Bankers and Front Window Cashiers. The role includes supervising staff, ensuring compliance with regulatory rules, and resolving customer service issues. Candidates should have...Full time
- CVS Health is seeking a Lead Director of Clinical AI to steer enterprise AI strategy and governance across production systems. You will lead a team of data scientists, partner with product and engineering, and ensure AI solutions meet clinical, regulatory, and quality standards...
$22 per hour
...are hiring immediately for a full time FOOD UNIT LEAD position. Location : Bank of America - 70 Batterson... ...efficiency and excellence in food and service. Determines work procedures, prepares work schedules and expedites work flow. Uses proper systems for completion of...Hourly payFull timePart timeLocal areaImmediate startRemote workWorldwideFlexible hoursEurest
Hartford, CT2 days ago- Connecticut Children's Medical Center in Hartford seeks a Clinical Pharmacist in Hematology/Oncology. You will design therapy, monitor outcomes, and dispense medications per SOPs, ACLS/PALS, and USP guidelines, serving as medication expert. You will supervise Pharmacy...
$144.2k - $288.4k
...us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. Lead Director, Clinical AI CVS Health is seeking an experienced technical leader in AI and machine learning to join CVS Health's enterprise clinical...Hourly payFull timeTemporary workWork experience placementLocal area- ...actual salary for this position will be determined by a number of factors, including the scope... ...the way for best-in-class solutions.As a Lead Architect, you will collaborate with... ...and evaluation Experience with MLOps & AI Ops practices and CI/CD pipelines for AI/ML systems...Full timeTemporary workWork experience placementLocal area
$128k - $192k
Director, Portfolio Lead - BA06DEWe’re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and... ...contact for organization financials, including outlook locks, op planning, monthly reserving, capitalization, financial...Full timeTemporary workWork at office3 days per week- ...Inc. is seeking a Case Manager to support individuals with disabilities in a hybrid work setup in Hartford, CT. You will oversee clinical management and supervise DSPs while coordinating with families and internal teams to ensure high-quality service delivery. Qualified...
- Syneos Health is seeking a Clinical Trial Manager to oversee site management, monitoring and data integrity from activation to closeout in a remote/US-based setting. You will ensure patient safety and regulatory compliance while coordinating with CRAs and central monitors...Remote job
- Waters is seeking a Senior Clinical Research Associate (Sr. CRA) to manage site monitoring and relationships across multiple clinical studies, ensuring high‑quality execution per GCP and regulatory standards. The role includes guidance to junior CRAs, investigator site...Remote job
- Connecticut Children's Medical Center is seeking a dedicated Emergency Department Clinical Education Specialist. This full-time position involves supporting professional development of nursing staff and providing leadership in educational initiatives. The ideal candidate...Full time
$82k
An innovative children's mental health organization in Connecticut seeks a Clinical Manager for its Psychiatric Residential Treatment Program. The role involves leading a dedicated team of clinicians, shaping treatment plans for children facing trauma, and ensuring a supportive...- Bob's Discount Furniture is seeking a Shipping Lead to perform real-time analysis and coordinate shipping operations at DC Taftville, CT. You will balance manpower, assign picking/loading tasks, and record outbound deliveries while supporting the Shipping Supervisor. The...Flexible hoursAfternoon shift
- Connecticut Children’s in Hartford is seeking a licensed psychologist to deliver comprehensive clinical services to patients and families, including individual, group and family therapy, within a multidisciplinary treatment team. The role includes collaboration with community...
$110k - $160.91k
...transmission infrastructure is essential. This role is focused on leading and overseeing routing and siting efforts for electric... ...wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any...Full timeFixed term contractCasual workWork at officeRemote workFlexible hoursShift work- ...across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and... ...customers, agents, employees, and partners. We're looking for a Senior Lead Experience Designer to join our Bond & Specialty Insurance (BSI...Full timeWork experience placementH1bLocal area
$112.7k - $193.2k
...our most sophisticated new Health Plan clients. The Governance Lead for New Client Implementations will be an individual contributor... ...results through collaboration across operational, network, and clinical functionsYou'll be rewarded and recognized for your performance...Minimum wageFull timeWork experience placementWork at officeLocal areaRemote work- ...across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and... ...the Opportunity?This position reports into the National Practice Lead as a strategic leader over a broad regional and / or product-specific...Full timeWork at officeLocal area
$160k
...Manchester, CT, seeks an experienced Veterinarian to join our well‑established small animal hospital as Medical Director, blending clinical medicine with leadership to strengthen care and outcomes. You will mentor the veterinary team, collaborate with the Practice...Relocation package- Hartford HealthCare is seeking a Clinical Documentation Specialist (CDS) 1 located in Farmington, CT. The CDS will perform extensive reviews of medical records and collaborate with healthcare professionals to ensure accurate clinical documentation. Responsibilities include...
- Catholic Charities, Hartford, CT, seeks a Clinical Coordinator to oversee a VOCA-funded peer recovery program. You will provide direct clinical services, supervise a peer recovery specialist, and ensure contractual compliance and data reporting. The role emphasizes program...
- Lead Advanced Practitioner-NICU-20 Hours Hartford, CT, United States (On-site) About Us... ...Balance of administrative responsibilities and clinical care to be primarily dayshift but... ...physicians and management/administration to determine advanced practitioner role in achieving...Work at officeFlexible hoursShift workDay shift
- RTX seeks an I4.0 & Ops Excellence Industrial Engineer Lead in a hybrid U.S. role to advance factory automation, digital thread integration, and connected factory capabilities. You will coach sites, lead cross-functional teams, and drive data-driven improvements across...
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Clinical Appeals Ops Lead: Determinations & Expedited. Be the first to apply!
