Summary of Position Responsible for overseeing the day-to-day operations of the Grievance and Appeal Specialists... to develop workflows, resolve appeal and grievance issues and implement quality improvements. Create and implement policies...
Summary of Position Perform clinical and administrative reviews within the Grievance and Appeals department, ensuring... to manage utilization within the benefit plan. Responsible for the review of grievance and appeal cases referred for clinical...
options and contributes to the development of a safe member centered service plan Consult with supervisor... that affect member eligibility. Coordinates with other departments, e.g. Care Management, Legal Affairs, Grievance and Appeals...