Appeals and Grievances Clinical Specialist - New York
1 day ago

Job Summary
The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services.Responsibilities
- Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of services.
- Rearch issues
- Reference and understand HF's internal health plans policies and procedures to frame decisions
Job description
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