Appeals and Grievances Clinical Specialist

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.

A&G works in collaboration with divisions within and outside the organization to resolve issues in a timely and compliant manner.

The A&G Clinical Specialist is the subject matter expert responsible for all clinical case development and case resolution…