Clinical Appeals Manager - Baltimore, MD

The Appeals Manager develops and executes the operational strategy for appeals administration in Maryland's Family and Medical Leave Insurance (FAMLI) program. · ...

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 ...

The Appeals · Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, · and determination of next steps for Commercial and FEP lines of business.The role requires collecting, · organizing and tracking information to facilitate and expedit ...

+ Job summary: The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse coverage decisions. + Qualifications: High School Diploma or GED, RN - Registered Nurse - State Licensure And/or Compact State Licensure ...

The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, · The incumbent is responsible for collecting, organizing and tracking information to facilitate and expedite processing of appeals and grievances received from a variety of ...

The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, · and determination of next steps for Government Program lines of business.We are looking for an experienced professional to work remotely from within the greater Baltimore m ...

The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. · ...

The Clinical Appeals Nurse completes research and evaluation of member and provider disputes regarding adverse decisions. The incumbent will work remotely from within the greater Baltimore metropolitan area and come into a CareFirst location periodically for meetings training and ...

We are looking for an experienced clinician to work remotely from within the greater Baltimore metropolitan area. ...

We are looking for an experienced clinician to work remotely from within the greater Baltimore metropolitan area. · The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. · ...

The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal rules and regulati ...

We are looking for an experienced clinician to work remotely from within the greater Baltimore metropolitan area. · The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. · We ...

The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, and determination of next steps for Commercial and Government Program lines of business. The incumbent is responsible for collecting, organizing and tracking information to f ...

The Clinical Appeals Nurse completes research and evaluation of member and provider disputes regarding adverse coverage decisions. We are looking for an experienced clinician to work remotely from within the greater Baltimore metropolitan area. · Investigates and analyzes written ...

We are looking for a Director, Medical Review & Appeals for our Government Programs lines of business. · ...

The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, · and determination of next steps for Commercial and Government Program lines of business. · ...

Assist servers in maintaining the cleanliness of their sections and inspect assigned restrooms every 30 minutes. · Maintain your assigned area in a visually appealing and service ready manner. · ...

The Clinical Appeals Nurse completes research and evaluation of member and provider disputes regarding adverse decisions. · Investigates appeals requests using nursing expert knowledge. · Responds to such requests with original letters upholding corporate policies and decisions. ...

The City of Baltimore offers limitless opportunities to help drive social impact while serving its citizens. · Conduct thorough data analysis of real property assessments. · ...

Nature of Work: The Employer-Employee Relations Representative performs at the journey and professional levels in employer-employee relations and serves as an advocate for management in formal adjudicatory settings. The primary responsibilities includes conducting and representin ...