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- Collaborate with Director to develop fully informed views and insights into the drivers behind data, and present findings clearly and concisely.
| - Conduct concurrent review of participant medical records to identify incomplete, inaccurate, or inconsistent clinical information.
ul>- Increases disease state and product knowledge to a variety of TA marketplace stakeholders, which may include patients, HCPs (both prescribing and non-prescribing healthcare stakeholders), Advanced Practice Clinicians, the multi-disciplinary clinical team, non-traditional clinical support teams., extended support staff and community organizations. This position will also support the design and development of TA educational resources, including disease state and management tools, healthcare provider resources, patient, care partner, community advocates, and consumer education materials and product programming.
Lincoln may decline to extend an offer or terminate employment for this role if it determines political contributions made could have an adverse impact on Lincoln's current or future business interests, misrepresentations were made, or for failure to fully disclose applicable political contributions and or fundraising activities. Working alongside dedicated and talented colleagues, we build fulfilling careers and stronger communities through a company that values our unique perspectives, insights and contributions and invests in programs that empower each of us to take charge of our own future. Acts as a liaison between clinical, technical, and administrative teams, focused on planning and executing implementations that fit existing workflows while supporting patient care and operational efficiency. Provides subject matter expertise and leads the deployment and integration of clinical programs, technologies, and workflows, ensuring alignment with regulatory requirements and organizational goals. p>We are seeking warm and razor-smart Licensed Clinical Social Workers with entrepreneurial spirits to perform therapy in nursing homes in Nebraska. Ivy Psychiatry is an NP founded organization that provides patients living in nursing homes with the quality psychiatric care they deserve. Omaha, Nebraska16 days ago p>We are seeking warm and razor-smart Licensed Clinical Social Workers with entrepreneurial spirits to perform therapy in nursing homes in Nebraska. Ivy Psychiatry is an NP founded organization that provides patients living in nursing homes with the quality psychiatric care they deserve. Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. Prepare cases for Medical Director Review ensuring that all pertinent information (i.e. case summary, contract information, internal and external responses, diagnosis, and CPT codes and descriptions) has been obtained during investigation and is presented as part of the case. Translates regulatory and coding requirements into practical guidance for internal teams and external partners Serves as a clinical subject matter resource during internal, vendor, or provider discussions Assists Director and Manager as needed to develop, introduce and support overall goals Develops linkages with specific departments on behalf of the Clinical Review area such as Data Management, Legal, Network Management, Compliance, Pharmacy and Complementary Networks. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the positions scope and responsibility, internal pay equity and external market salary data.
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