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Clinical Specialist
R021662 The Appeals & Grievances Clinical Specialist is responsible for receiving, investigating, and responding verbally and in writing to member and provider appeals and grievances involving review of clinical information. - Ensures that appeals and grievances are properly classified (e.g. denial of service, denial of payment, or a grievance about a provider). - Processes appeals and grievances within NYS and federal regulatory time frames, which could be standard (long period time) or expedited (3 day turnaround). - Handles appeals and grievances in accordance with internal company policy which includes entering data into appropriate medical management systems. - Collaboratives with other departments to thoroughly investigate all appeals and grievances from denial of treatment to quality of care issues. - Prepares for and participates in regulatory site visits. - Additional duties as assigned WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*:
- Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360
- All Other Locations (within approved locations): $73,400 - $108,160