WellpathMedford (OR)
our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time.
How you make a difference:
As a Health Services Administrator RN, you'll oversee and assess the Health Care Delivery Program...
Ventura MedStaffMedford
Ventura MedStaff is seeking an experienced Director of Nursing Registered Nurse for an exciting Travel Nursing job in Medford, OR. We offer assignments in the fields of nursing, therapy, and allied health, and our benefits include travel and license reimbursements, and assistance with continuing edu...
The Inline GroupNewport (OR)
Coverage.
• Generous Paid Leave.
• 11% County Contribution into 401(k).
• Fully Funded Health Savings Account.
-$40,000 County Paid Life Insurance.
• 10 Paid Holidays Per Year.
• Up to $50k National Health Service Corps (NHSC) Loan Repayment Program for eligible...
Enterprise Medical RecruitingPortland
with a flexible schedule. Practice Highlights The group comprises 14 Internal Medicine Physicians, mental health services, and other onsite specialty care. Flexible schedule Full-time or part-time Hybrid onsite/remote option Enjoy the convenience of having...
Universal Health ServicesPortland
downtown Portland- is a 94 bed, freestanding Psychiatric hospital and outpatient center specializing in mental health and substance use disorder treatment. We provide a wide range of service and programs that offer evidence-based treatment proven to have...
Corvallis Clinic PCCorvallis (OR)
The Corvallis Clinic is actively recruiting a behavioral health professional to provide integrated behavioral health services to children and adolescents in our pediatric department.
PRACTICE OPPORTUNITY
• Work closely on-site with medical...
Universal Health ServicesPortland
Department of Universal Health Services, Inc.
About Cedar Hills Hospital:
• 94-bed, freestanding psychiatric hospital
• Outpatient center specializing in mental health and substance use disorder treatment
• Evidence-based treatment with positive outcomes...
Macpower Digital Assets Edge Private Limited (MDA Edge)Milwaukie
at the facility - department level for a defined department(s), in support of Health & Services System and Regional goals. This includes strategically ensuring a balance of optimal and efficient patient care; staff, patient, and physician satisfaction...
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OR - Appeals-Grievance Coordinator - Days - ending 4/30
HexaQuEST Global - Healthcare | Corvallis | www.resume-library.com |
Job Description:
JOB SUMMARY/PURPOSE
Responsible for grievance and appeals coordination and resolution for all Samaritan Health Plan (IHN, SAHP, Commercial, Choice) members who engage with the grievance process. Coordinates and resolves complaints and inquiries (included in grievances ) from regulatory agencies, consumer rights organizations and legislators.
Responsible for the documentation, monitoring and regulatory reporting obligations
DEPARTMENT DESCRIPTION
Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc.
offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services mission of Building Healthier Communities Together.
EXPERIENCE/EDUCATION/QUALIFICATIONS
High school diploma or equivalent required.
Bachelor s degree in a related field preferred.
Three (3) years health plans or health insurance experience required.
Position Urgency:
Normal
Shifts:
Days (0830-1700) occasional weekend, ending 4/30
State License Details:
Not Needed
Minimum Years of Experience:
3
Minimum Guaranteed Hours:
No Guarantee
Specialty Type:
Clerical
Sub Specialty:
Patient Service Coordinator
Bilingual:
No
EMR Used:
EPIC
Vacation Coverage Required:
No
JOB SUMMARY/PURPOSE
Responsible for grievance and appeals coordination and resolution for all Samaritan Health Plan (IHN, SAHP, Commercial, Choice) members who engage with the grievance process. Coordinates and resolves complaints and inquiries (included in grievances ) from regulatory agencies, consumer rights organizations and legislators.
Responsible for the documentation, monitoring and regulatory reporting obligations
DEPARTMENT DESCRIPTION
Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc.
offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services mission of Building Healthier Communities Together.
EXPERIENCE/EDUCATION/QUALIFICATIONS
High school diploma or equivalent required.
Bachelor s degree in a related field preferred.
Three (3) years health plans or health insurance experience required.
Position Urgency:
Normal
Shifts:
Days (0830-1700) occasional weekend, ending 4/30
State License Details:
Not Needed
Minimum Years of Experience:
3
Minimum Guaranteed Hours:
No Guarantee
Specialty Type:
Clerical
Sub Specialty:
Patient Service Coordinator
Bilingual:
No
EMR Used:
EPIC
Vacation Coverage Required:
No
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