As it relates to clinical appeals and quality of care complaints and grievances and strict state and federal deadlines, is responsible for research, review and facilitation of Medicaid and Medicare processes. Coordination of effort may involve coordinating multiple programs and commercial insurance. Establishes and maintains cohesive and successful interdepartmental relationships within the organization and with external customers. Responsible for interpreting and accurately documenting determinations. Monitors assigned cases and trends while ensuring that resolution meets state and federally mandated timelines. Utilizes and evaluate trend data for reporting and to suggest action plans for quality improvement initiatives and coordinate audits.
Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.
Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at email@example.com.
Neighborhood is an EOE M/F/D/V and an E-Verify Employer