Clinical Appeals Specialist

Job Description***Residents in CENTRAL Time Zone preferred. Candidates who do not live in Central Time zone must work CENTRAL DAYTIME BUSINESS HOURS.Work Schedule: 4 days a week - 10hrs a day. Schedule will be alternating every 4 weeks Monday-Thursday and Wed - Saturday. JOB DESCRIPTIONJob SummaryClinical Appeals is responsible for making appropriate and...

**Molina Healthcare Job Description:**">We are seeking a dedicated Clinical Appeals Nurse to contribute to our team's success. As a clinical appeals nurse, you will perform complex clinical/medical reviews and make decisions on medical claims appeals within compliance standards.**Key Tasks and Responsibilities:**">">Independent re-evaluation of medical...

Your RoleThe Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Appeals and Grievances RN Senior will report to the Manager of the Appeals and Grievances team. In this role you will perform accurate and timely clinical review of...

Your RoleThe Medicare Sales Operations and Analysis team is responsible for Complaint Tracking Module (CTM) processing. The Appeals and Grievance, Representative, Specialist - Medicare CTM will report directly to the Manager, Sales Analysis and Operations. In this role you will address incoming CTMs per CMS SLAs, working with multiple stakeholders to...

Your RoleThe Medicare Sales Operations and Analysis team is responsible for Complaint Tracking Module (CTM) processing. The Appeals and Grievance, Representative, Specialist - Medicare CTM will report directly to the Manager, Sales Analysis and Operations. In this role you will address incoming CTMs per CMS SLAs, working with multiple stakeholders to...

**Clinical Appeals Nurse Position:**">Molina Healthcare is seeking a highly skilled Clinical Appeals Nurse to join our team. As a clinical appeals nurse, you will be responsible for reviewing and making decisions on medical claims appeals within compliance standards.**Key Responsibilities:**">">Conduct thorough clinical/medical reviews of previously denied...

Job SummaryWe are seeking a highly motivated and compassionate Clinical Mental Health Specialist to join our team. The ideal candidate will possess excellent communication and interpersonal skills, with the ability to work effectively with individuals from diverse backgrounds.The Clinical Mental Health Specialist provides mental health support services to...

Telecare Corporation is a leading provider of behavioral health services, delivering exceptional care to individuals with mental illness.The Clinical Services Specialist II role is an exciting opportunity to make a difference in the lives of our members served. Working under the supervision of a licensed clinician, you will provide clinical and casework...

About Sequel Sequel Med Tech is an early-stage company developing the next generation of precision drug delivery devices. Job Overview As a Clinical Diabetes Specialist (CDS), you will partner with a Territory Business Leader (TBL) to successfully launch a new innovative insulin pump and future Sequel products. Your primary responsibility is to deliver...

We are looking for a skilled Warehouse Operations Specialist to join our team at Floor & Decor. The ideal candidate will be responsible for:Receiving products from delivery trucks and storing them in a secure and organized manner;Ensuring the sales floor is well-stocked and visually appealing;Participating in regular inventory counts to maintain accuracy and...

Job DescriptionVolt is seeking an experienced Clinical Territory Development Specialist to join our team. As a key member of our sales force, you will be responsible for developing and executing sales strategies that drive revenue growth and expand our presence in the catheterization lab market.You will work closely with physicians, clinical specialists, and...

Are you looking for a challenging and rewarding career in the food industry? As a Food Preparation Specialist at Stater Bros., you'll play a critical role in preparing food for customer consumption. This includes tasks such as preparing ingredients, cooking meals, and presenting dishes in an attractive and appealing way.Responsibilities:Prepare food...

Job Description Job Description About SequelSequel Med Tech is an early-stage company developing the next generation of precision drug delivery devices.Job OverviewAs a Clinical Diabetes Specialist (CDS) you will partner with a Territory Business Leader (TBL) to successfully launch a new innovative insulin pump and future Sequel products. Your primary...

About Sequel Sequel Med Tech is an early-stage company developing the next generation of precision drug delivery devices. Job Overview As a Clinical Diabetes Specialist (CDS) you will partner with a Territory Business Leader (TBL) to successfully launch a new innovative insulin pump and future Sequel products. Your primary responsibility is to deliver...

About the RoleClinical Radiation Specialists play a crucial role in delivering high-quality radiation therapy treatments to patients. At Customer Value Partners (CVP), we seek an experienced professional to join our team at the Tibor Rubin VA Medical Center in Long Beach, CA.ResponsibilitiesOperate linear accelerators and other radiation therapy equipment to...

Company OverviewMolina Healthcare Services works with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum. This includes behavioral health and long-term care for members with high need potential.Job SummaryWe are seeking a skilled Clinical Review Specialist to...

At Advantage Solutions, we are seeking a skilled Visual Merchandising Specialist to enhance the shopping experience for customers within grocery stores near you. As a key member of our team, you will play a vital role in maintaining the visual appeal of the stores, ensuring products are well-presented, and displays are aesthetically pleasing.The ideal...

You MatterIt's more than a career. It's a calling.Everything we do is about taking care of people.Taking Care of Our Patients.Taking Care of Our People.Taking Care of Our Partners.Perks and BenefitsIn addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family...

Job Overview: We are seeking a highly skilled Clinical Psychiatric Specialist to join our team at Student Health Services. As a key member of our staff, you will provide professional services in psychiatry, including psychiatric assessment, consultation, medication management, and referrals to CSULB students.Key Responsibilities:Provide psychiatric...

Clinical Management Consultants Careers is committed to providing exceptional care to the region's most vulnerable patients. We are currently seeking a highly skilled Nurse Manager Neonatal Intensive Care Unit to lead our NICU team in delivering high-quality care. The ideal candidate will be an accomplished RN leader with a strong background in neonatal...