Clinical Appeals Manager - Baltimore
1 month ago
Job summary
This role manages the appeal process for members and providers who appeal on behalf of members for Commercial lines of business.This position is responsible for ensuring quality management of the clinical appeal process to reduce the risk of State and Federal Regulatory fines and sanctions.
We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model.
- Develops, establishes and implements a compliant appeal process with dynamic goals resulting in the full and fair review of appeals.
- Accountable for ensuring that appeal decisions are accurate based on the member's health benefit contract and CareFirst Medical Policy.
Job description
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