Ability to maintain a high-volume caseload and adhere to the timeliness standard of appeals while conducting the due process review. Assist in the achievement of a high performing and positive work environment that will promote the Client’s Mission. Daily receives and reviews appeals for potential resolution within policy guidelines. If a resolution cannot be found, make outreach. Conduct outreach to explain the state's actions related to Client’...
remote role with the expectation of going to Hopewell, NJ Site, once a month. Job Summary. This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Responsibilities. Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of str...
remote role with the expectation of going to Hopewell, NJ Site, once a month. Job Summary. This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Responsibilities. Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of str...
