Manager, Appeals

Job Summary Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid KNOWLEDGE/SKILLS/ABILITIES Responsible for the comprehensive research and resolution...

Job DescriptionJOB DESCRIPTIONJob Summary Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid KNOWLEDGE/SKILLS/ABILITIES Responsible for the...

**_Appeals & Grievances Health Claims Processing Specialist (REMOTE)_**Position Summary**: Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and providers (or authorized representatives) following the standards and requirements established by the Centers for Medicare and Medicaid. **Position...

Job Summary Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider complaints and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and...

Job DescriptionJOB DESCRIPTIONJob Summary Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid KNOWLEDGE/SKILLS/ABILITIES Responsible for the...

**JOB DESCRIPTION****Job Summary**Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards.**We are seeking a Registered Nurse with previous Inpatient/outpatient appeals knowledge/experience. The candidate should have MCG criteria knowledge, critical thinking skills, and strong...

Job Description Job Summary The Specialist, Member Rights serves as a member advocate within the agency. This position ensures that members are informed of their rights and supports members through mediation and problem solving with interdisciplinary teams (IDTs). Maintains and manages an accessible appeals and grievance system for members to...

Job DescriptionJob DescriptionJob Summary The Specialist, Member Rights serves as a member advocate within the agency. This position ensures that members are informed of their rights and supports members through mediation and problem solving with interdisciplinary teams (IDTs). Maintains and manages an accessible appeals and grievance system for members to...

Under the Supervision of the Maintenance Manager, the Maintenance Technician is responsible to assist and maintain the overall appearance and maintenance needs of the community. Responsibilities include curb appeal; help the Maintenance Manager; coor Maintenance Technician, Technician, Maintenance Manager, Building, Customer Service, Maintenance, Property...

Your Role The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with their care including a multidisciplinary team and the member’s treating physicians. The Registered...

Job DescriptionJOB DESCRIPTIONJob Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding...

**TITLE** GOVERNMENT ADMINISTRATION MANAGER *** Reports to AMM Director of Administration. Individual is responsible for overseeing all aspects of AMM operations utilized to provide Fiscal Intermediary services to assigned Government contracts, Fiscal Intermediary clients, including maintaining communication with client leadership, resolving problems, and...

Job Summary The position will oversee and manage the Vendor Management team responsible of managing and coordinating the vendor activities between contracted entities and Molina Healthcare to support enrollment, claims, contact center, appeals and grievances, risk adjustment, medical records, quality, Provider and/or other functions under operations across...

**JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy...

Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including...

Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including...

Your RoleThe Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including...

Job Description: Position is fully remote and will be a temp role through 3/31/23. Position has the option to go perm based on positive work. Candidates can sit anywhere in the US and schedule will be M-F 9AM-5PM local time. The training schedule will be M-F 9AM-5PM EST. Daily responsibilities will include the following: Candidates will be reviewing medical...

Summary This position is located in the Department of Homeland Security (DHS), U.S. Customs and Border Protection (CBP). The General Counsel, who is appointed by the President with the advice and consent of the Senate, is the Department's chief legal advisor and principal legal advisor to...

Job Description Molina Healthcare is in search of an I.T.U. Tribal Liaison, specifically with in-depth knowledge of Managed Care. Candidates for this role must reside within the state of New Mexico and be open to state-wide travel. We are also seeking someone who has a great deal of experience working with Tribal organizations. Highly preferred candidates...