This position is 100% remote, working from
home. The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are…
Experience Details: Combined experience in utilization management, case management,
homehealth and clinical. Experience with Diamond, Jiva
or InterQual.
Graduate of an ACEN (Accreditation Commission for Education in
Nursing), CCNE (Commission on Collegiate
Nursing Education), NLN (National League for
Nursing) or…
Bachelor of Science in
nursing in a related
health field. Maintain medical records in accordance with department
or company policy and/or any applicable federal…
EDUCATION: High School Diploma
or equivalent, supplemented by college courses
or an accredited training program in business
or office administration
or related…
The purpose of this position is to ensure that Archcare Community Life MLTC members obtain timely, cost-effective, quality care in the appropriate setting.
No supervisory
or management authority. Provides data management support for refugee housing, legal,
health services. A bachelor’s degree is preferred.
Reviews cost, quality, safety, utilization, and value data regularly with
nursing leaders, clinical leaders, and
health system executives; responsible for both…
Graduate of an accredited school of
nursing. This role is remote and work from
home, with occasional travel required. Valid Driver’s License in good standing.