health plan (Medicare Advantage, Medicaid and MLTC). You'll own clinical grievances and appeals from intake to final decision... and notification Apply medical necessity criteria (InterQual/MCG) to outpatient, home health, DME and LTSS cases Prepare case files...
construction methodologies Preferred Certifications Certified Construction Manager (CCM) OSHA certification Other relevant... & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation...
please apply! The Chronic Care Management (CCM) Assistant – Clinical Check Specialist plays a critical role in Carda Health's private..., which results in complications for patients and at least $190B in costs. At Carda Health, we've re-imagined rehab. Our program...
+ years of progressive RN experience in healthcare. 2+ years working directly in grievance and appeals at a health plan...) with confidence. Experience with outpatient, home health, community-based or long-term care services. Inpatient-only or hospital...
please apply! The Chronic Care Management (CCM) Assistant – Clinical Check Specialist plays a critical role in Carda Health's private..., which results in complications for patients and at least $190B in costs. At Carda Health, we've re-imagined rehab. Our program...
Company Description Henry Ford Health partners with millions of people on their health journey, across Michigan... and around the world. We offer a full continuum of services from primary and preventative care to complex and specialty care, health...
social determinants of health needs. Our approach emphasizes compliance, scalability, and high-quality member experiences... members, many of them older adults and Medicare beneficiaries, who are dealing with complex health concerns and a healthcare...
. Negotiate contracts and ensure all external partners meet performance and quality expectations. Health, Safety, & Compliance... a commitment to communicating, improving and adhering to health, safety and environmental policies in all work environments...
Job Summary RN, Health Plan Care Manager Talented Medical Solutions Contract In-Office | Roseville, CA, United...;5-10 years of acute and ancillary experience in multiple modalities. Preferred experience working in a health plan...
RN, HEALTH PLAN CARE MANAGER Job Summary: Manages the development, implementation, and evaluation of care management...) Licenses & Certifications: Registered Nurse (RN) licensure in state of practice (Required) Certified Case Manager (CCM...