Title: Nurse Appeals (Grievance & Appeals) Job Responsibilities: The Nurse Appeals role involves a range of responsibilities focused on managing and processing medical necessity appeals from members and providers. Key duties include: - Supporting legal, management, and executive leadership by managing State Fair...
ACA, ERISA, the Code, HIPAA, and COBRA. - Develop and... present materials on various health and welfare compliance-related issues to internal sales teams and external clients. - Establish effective working relationships with internal partners, clients, and carriers. - Function as part of a...
Title: Nurse Appeals (Grievance & Appeals) Job Responsibilities: The Nurse Appeals role involves investigating and processing medical necessity appeal requests from members and providers. Key responsibilities include: - Supporting legal, management, and executive leadership by managing State Fair Hearing and External Medical Review...
Contract Manager The candidate will manage the full life cycle of Pharmacy Benefit Management (PBM) contracts from RFP through client contract execution. Oversee the contract approval process, ensuring compliance, version control, and support the negotiation and execution of standard and...
Title: Senior Corporate Counsel - Benefits Job Responsibilities: - Provide legal guidance and strategic support for the company's . employee benefit plans and programs, ensuring compliance with applicable laws and regulations. - Advise Benefits and other internal teams on the design, administration, and...