Job description Bachelor's Degree in Nursing with an active and valid PHRN license At least 1 year of experience in Appeals and Grievances workstreams, with a focus on Medicare Part C Appeals Minimum of 1 year experience in a similar role o...
We are seeking a Senior Systems Developer (Database Developer) to lead systems analysis, development, data integration, and support for complex enterprise data platforms. This role focuses on EMR/EHR data integration, ETL pipelines, cloud-b...
Requirement : Registered Nurse (PHRN/USRN) Minimum 1 year of experience using InterQual criteria At least 2 years of acute care bedside experience, preferably as an ER or ICU nurse Required experience in Utilization Management with a U.S.-b...
Job Summary The Operations Manager for Appeals is responsible for managing and overseeing operations related to clinical appeals. Ensures compliance with industry standards and regulatory requirements. Collaborates closely with internal and...
Key Responsibilities: 1 Grievance Handling : Investigate and resolve member grievances related to Medicare Part D drug coverage, claims, and pharmacy issues Ensure all grievances are resolved within required CMS timelines and documented app...