Summary. Responsible for providing daily clerical support to the Appeals & Grievance Unit of the Member Experience Department. Essential Duties and Responsibilities. Essential duties and responsibilities include, but are not limited to:. Member Services. Responsible for the daily print and mailing of member correspondence.. Assists with the daily tracking of incoming member correspondence in the member database and case assignment.. Assists with the daily logging, tracking, and monitoring of incoming Appeals & Grievances (CTMs, Grievances, Appeals, Fast Tracks, etc.,) through multiple channels... view job details
Appeals & Grievance Coordinator. The appeals and grievance coordinator is responsible for the day-to-day receipt, investigation and processing of member grievances and appeals. Essential Duties and Responsibilities. (May include but are not limited to). Acknowledge the receipt of any member complaint type assigned including but not limited to grievances, appeals, CTM (Complaint Tracking Module), and LEP Reconsiderations. Ensure medical records requests and information needed to investigate the member’s issue are received and relevant. Utilize member resolution tools and resources and critical ... view job details
The Alignment Care Anywhere program is a physician-led and advanced practice clinician-driven program that is intended to care for and support Alignment Healthcare patients by proactively providing an additional level of medical and social support in the comfort of their home or in one of our Alignment Clinics. This program provides patients with medical and social support when and where they need it, with the goal of preventing unnecessary hospitalizations, health complications, and unmanaged disease progression that can occur when timely clinical interventions are not provided or are not acc... view job details
The Care Coordinator is responsible for UM/CM Coordinator functions as defined below. General Duties/Responsibilities (May include but are not limited to):. Review Daily Census for new Admissions. Obtain medical records from Provider offices, hospitals and SNF’s. Attach medical records to authorizations. Enter referral requests/authorizations in system. Monitor Fax Folders. Monitor task lists in EHR. Creates cases and tasks in Case Management module for Hospital and SNF discharges. Post discharge scheduling of appointments. Follow up scheduling and re-scheduling of no-show appointments. Assist... view job details
Care Coordinator, SNP. Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time. By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are pass... view job details
Position Summary:. The Case Manager is responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs.. The Case Manager delivers care to members utilizing the nursing process and effectively interacts with members, care givers, and other interdisciplinary team participants. The Case Manager will assist with closing gaps in care and resolving barriers that prevent members from attaining improved health.. The. Case Manager will connect with members telephonically. General Duties/Responsibilities:. (May include but are not ... view job details
Position Summary:. The Case Manager is responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs.. The Case Manager delivers care to members utilizing the nursing process and effectively interacts with members, care givers, and other interdisciplinary team participants. The Case Manager will assist with closing gaps in care and resolving barriers that prevent members from attaining improved health.. The. Case Manager will connect with members telephonically. General Duties/Responsibilities:. (May include but are not ... view job details
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time. By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transformi... view job details
Position Summary:. The Claims Delegation Oversight Auditor (CDOA) reports directly to the Claims Delegation Oversight Manager (CDOM). The CDOA assists the CDOM in obtaining the necessary information from the IPAs, coordinating audits, performing data validations and assists with compliance reporting and submissions to AHCs internal Compliance Department. The CDOA also assists the CDOM with audits conducted for Alignment Health Plan’s delegated entities as it relates to claims processing.. General Duties/Responsibilities:. (May include but are not limited to). Assists with the oversight and a... view job details
Job Number:. 2201. Position Title:. Claims Mailroom Support Clerk. External Description:. Claims Mailroom Support Clerk. Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time. By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who a... view job details