Top 47736 Program Specialist Clinical Jobs

Appeals & Grievances Clinical Specialist
Healthfirst —Remote
- $83,100 - $120,360 a year
- Full-time
- Mid-level
- Data entry
- Nursing
- Health insurance
- Dental insurance
Lead Clinical Documentation Specialist
Ascension —Remote
- $96,208.99 - $134,109.89 a year
- Full-time
- Remote
- High school diploma or GED
- Mentoring
- 1 year
- Disability insurance
- Health insurance
Registered Nurse Care Manager - Clinical Diabetes Educator; $30,000 Sign On, $15,000 Relocation, and Retention Bonus eligible
Yukon-Kuskokwim Health Corporation —Bethel, AK
- From $54.95 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Paid holidays
- Disability insurance
Pharmacist Clinical Specialist
SSM Health —St. Louis, MO
- Full-time
- Acute care
- Psychiatry
- Inpatient
- Paid parental leave
- Health insurance
Urgent Care Physician (MD/DO)
UCSF Health | GoHealth Urgent Care —Mill Valley, CA
- Full-time
- Medicine
- Urgent Care
- Mid-level
- Health insurance
Quick Apply
Physical Therapist PT Home Health PRN
Elara Caring —Dexter, MO
- Part-time
- Background check
- Management
- Up to 50% travel
- Paid holidays
- Health insurance
Quick Apply
Market Physician Executive (MPE)
Monogram Health Professional Services —Brunswick, GA
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
Market Physician Executive (MPE) - Float
Monogram Health Professional Services —Georgia
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
Physician-OB/GYN (Part-Time)
FETTER HEALTH CARE NETWORK INC —Charleston, SC
- Part-time
- Medicine
- Microsoft Outlook
- Surgery
Quick Apply
1099 Contractor - Licensed Clinical Psychologist
Family Guidance Centers —Midlothian, VA
- $95,000 - $135,000 a year
- Part-time
- Private practice
- Doctoral degree
- Adults
- Flexible schedule
- Referral program
Quick Apply
14d
Medical Specialist 2 (Doctor; MD)
Sunmount DDSOO —Tupper Lake, NY
- $237,121 a year
- Part-time
- Hybrid work
- Background check
- Medicine
- Management
- Health savings account
- Health insurance
Quick Apply
Market Physician Executive (MPE)
Monogram Health Professional Services —Valdosta, GA
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
CAA-Certified Anesthesiologist Assistant
ECAA - Anesthesia Specialists —Raleigh, NC
- Full-time
- RN License
- PALS Certification
- BLS Certification
Quick Apply
RN - Integrated Medicine
University of Missouri Health Care —Columbia, MO
- $34.46 - $51.02 an hour
- 12 hour shift
- Nursing
- Patient monitoring
- RN License
- Paid holidays
- Loan repayment program
Veterinary Emergency Nurse Manager
Veterinary Care and Specialty Group —Chattanooga, TN
- ER
- Acute care experience
- Senior level
- Paid holidays
- Health insurance
Quick Apply
Physical Therapist PT Home Heath - $10K Sign on Bonus
Elara Caring —Elgin, IL
- $95,000 - $110,000 a year
- Full-time
- Up to 50% travel
- Physical & Rehabilitation Medicine
- Mid-level
- Travel reimbursement
- Continuing education credits
Quick Apply
Primary Care Physician Part Time
MEDIKO INC —Redding, CA
- $190 - $200 an hour
- 8 hour shift
- CPR Certification
- Medicine
- Psychiatry
- Wellness program
- 401(k)
Quick Apply
Physician - (Optometrist/Ophthalmologist)
FETTER HEALTH CARE NETWORK INC —Summerville, SC
- Full-time
- Medicine
- Microsoft Outlook
- 5 years
- Employee discount
Quick Apply
Market Physician Executive (MPE) - Float
Monogram Health Professional Services —Savannah, GA
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
Registered Respiratory Therapist – Neuro Expansion
Cleveland Clinic —Cleveland, OH
- $36.75 - $48.55 an hour
- Rotating weekends
- Medication administration
- PALS Certification
- Hospital
- Dental insurance
- Vision insurance

I want to receive the latest job alert for Program Specialist Clinical

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Program Specialist Clinical jobs near

Appeals & Grievances Clinical Specialist

Healthfirst -
Remote

Apply Now

Job Details

Full-time
$83,100 - $120,360 a year

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance
Life insurance

Qualifications

Nursing

Full Job Description

Position Summary: The Appeals & Grievances Clinical Specialist is responsible for receiving, investigating and responding verbally and in writing to member and provider clinical appeals and grievances.

Duties and Responsibilities:

Ensures that appeals and grievances are properly classified (e.g. denial of service, denial of payment, or a grievance about a provider)
Processes appeals and grievances in accordance with internal company policy
Enters data into appropriate medical management services
Collaborates with other departments to thoroughly investigate appeal and grievances.
Prepares for and participates in regulatory site visits.
Additional duties as assigned.

Minimum Qualifications:

RN
Preferred Qualifications:

Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management.
Understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual or Medicare Guidelines.
Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as corporate email and virtual filing system. (ie. Macess).
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360
All Other Locations (within approved locations): $73,400 - $108,160

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

73400-108160

Apply Now

Refine Your Search

Program Specialist Clinical jobs

Appeals & Grievances Clinical Specialist

Lead Clinical Documentation Specialist

Registered Nurse Care Manager - Clinical Diabetes Educator; $30,000 Sign On, $15,000 Relocation, and Retention Bonus eligible

Pharmacist Clinical Specialist

Urgent Care Physician (MD/DO)

Physical Therapist PT Home Health PRN

Market Physician Executive (MPE)

Market Physician Executive (MPE) - Float

Physician-OB/GYN (Part-Time)

1099 Contractor - Licensed Clinical Psychologist

Medical Specialist 2 (Doctor; MD)

Market Physician Executive (MPE)

CAA-Certified Anesthesiologist Assistant

RN - Integrated Medicine

Veterinary Emergency Nurse Manager

Physical Therapist PT Home Heath - $10K Sign on Bonus

Primary Care Physician Part Time

Physician - (Optometrist/Ophthalmologist)

Market Physician Executive (MPE) - Float

Registered Respiratory Therapist – Neuro Expansion

I want to receive the latest job alert for Program Specialist Clinical

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected