Appeals and Grievances Clinical Specialist Job at Healthfirst (New York City)

Appeals and Grievances Clinical Specialist

The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, griev...

Location

United States , New York City; Lake Mary

Salary:

73400.00 - 120360.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

RN, LPN
Bachelor’s degree
Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management
Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines
Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as corporate email and virtual filing system, (ie. Maces)
Experience with care management systems, such as CCMS, TruCare and Hyland
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment

Job Responsibility

Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of services
Research issues
Reference and understand HF’s internal health plans policies and procedures to frame decisions
Interpret regulations
Resolve cases and make critical decisions
Update file documentation such as the file notes and case summary
Manage all duties within regulatory timeframes
Communicate effectively to hand-off and pick-up work from colleagues
Work within a framework that measures productivity and quality for each Specialist against expectations
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

What we offer

medical, dental and vision coverage
incentive and recognition programs
life insurance
401k contributions

Fulltime

Appeals and Grievances Clinical Specialist

The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, griev...

Location

United States , New York City; Lake Mary

Salary:

73400.00 - 120360.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

RN, LPN OR Dental Hygienist
Bachelor’s degree
Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management
Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines
Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as corporate email and virtual filing system, (ie. Macess)
Experience with care management systems, such as CCMS, TruCare and Hyland
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment

Job Responsibility

Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of services
Research issues
Reference and understand HF’s internal health plans policies and procedures to frame decisions
Interpret regulations
Resolve cases and make critical decisions
Update file documentation such as the file notes and case summary
Manage all duties within regulatory timeframes
Communicate effectively to hand-off and pick-up work from colleagues
Work within a framework that measures productivity and quality for each Specialist against expectations
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

What we offer

medical, dental and vision coverage
incentive and recognition programs
life insurance
401k contributions

Fulltime

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Nursery Assistant

Are you passionate about early years education, supporting children's developmen...

Location

United Kingdom , Girton

Salary:

25724.00 - 26640.16 GBP / Year ▼

360 Resourcing Solutions

Expiration Date

Until further notice

Requirements

Strong written and verbal communication skills
Excellent organisational ability and attention to detail
Provide outstanding customer service
Have good time management, meeting deadlines
A commitment to working within Early Years Childcare

Job Responsibility

Use a friendly approach with parents and carers, children, and colleagues
Provide a safe, stimulating, and educational environment for the children to learn, play, explore and develop.
Maintain a homely environment for all children, which is clean and organised
Implement interesting and inspiring activities for children to learn through play
Build relationships with Key Children, record their interests and achievements through observations
Ensure that you understand and follow company Policies and Procedures
Safeguarding is a shared responsibility to protect children, parents, and staff from harm
Maintain strictly professional relationships and report any complaints or concerns to management in accordance with company policy and procedures.
Attend and actively participate in staff meetings and training, parent information sessions and functions as appropriate
including marketing events and activities that may run during the evening or at the weekend

What we offer

Birthday Off
6 fully paid sick days
Cashback Healthcare Plan
Retail Discounts
Recognition & Reward
50 % Childcare Discount
24/7 Virtual GP Access
24/7 Counselling Support
Discounted gym Membership
Personal Financial Advisor Access

Fulltime

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Location

United Kingdom , London

Salary:

55000.00 GBP / Year

360 Resourcing Solutions

Expiration Date

Until further notice

Requirements

4+ years in a senior food production or operations role, ideally within premium/artisan food, QSR, or chilled food manufacturing
Demonstrable experience running cook-chill systems and large-scale hot and chilled production
A track record of implementing lean manufacturing and automation projects
Strong commercial acumen, confident with costing, yield, and the relationship between production decisions and margin
Experience leading teams of 10+ across multi-shift operations
Excellent project management skills, facility design or scale-up experience a strong advantage
A genuine love of food, and alignment with our values around quality and Italian food culture
Right to Work in the UK

Job Responsibility

Lead end-to-end food production, including cook-chill systems, NPD pipelines, and daily operations across hot and chilled lines
Drive facility optimisation and scale-up projects as Lina Stores grows
Introduce and embed production automation and lean manufacturing principles
Support and innovate process and yield optimisation programmes
Support margin management across the full product range
Manage, mentor, and develop a multi-disciplinary production team across multi-shift operations
Oversee inventory systems and partner with supply chain to ensure material availability
Collaborate with NPD to bring new products from concept to production-ready stage efficiently
Maintain the highest standards of food safety, hygiene, HACCP, and regulatory compliance alongside the Building Manager

What we offer

50% staff discount across all Lina Stores restaurants, bars, and delis
Discount on retail and online shop products
28 days’ holiday including bank holidays, increasing with service
Workplace pension scheme
Enhanced family-friendly policies
Employee Assistance Programme and wellbeing support
Long-service rewards and career development across the Lina Stores group

Fulltime

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Teaching Assistant for SEMH Needs

Make a Real Difference: Teaching Assistant for SEMH Needs. Are you a compassiona...

Location

United Kingdom , Westbury, Wiltshire

Salary:

88.00 - 90.00 GBP / Day

Randstad

Expiration Date

June 04, 2026

Requirements

Patient, empathetic
calm demeanour
excellent communication and interpersonal skills
strong team players
ability to follow instructions effectively
relevant experience and qualifications desired
willingness to learn
positive attitude
experience working with children with SEMH needs highly desirable but not essential
ability to track progression in attainment

Job Responsibility

Providing direct support to pupils with SEMH needs
helping to create and maintain a positive and engaging learning environment
fostering academic progress and encouraging personal growth
collaborating effectively with teachers and other support staff to ensure holistic student development

What we offer

PAYE
Referral Bonus
training and education
Safeguarding
Prevent

Fulltime

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Assistant Marketing Manager

The Marketing Assistant Manager is part of an important team that creates and ex...

Location

India , Mahabaleshwar

Salary:

Not provided

Marriott Bonvoy

Expiration Date

Until further notice

Requirements

2-year degree from an accredited university in Marketing, Public Relations, Business Administration or related major and 2 years experience in the sales, marketing, digital or related professional area
hospitality marketing or digital advertising experience preferred OR 4-year bachelor's degree in Marketing, Public Relations, Business, or related major
no work experience required.

Job Responsibility

Assists with the execution of the annual marketing plan to budget
Provides support to Operations, Food & Beverage and Sales teams to execute promotions and campaigns to target in-house guests with promotions that drive incremental revenue to the hotel
Works with advertising agency on the tactical advertising campaigns' creative and media plans, particularly for food and beverage promotions
Assists with the management of F&B media schedules email marketing and display advertising
Stays informed about the status, performance evaluation, opportunities, and issues related to online programs and initiatives
Helps verify that all advertising for the hotel in digital channels is in alignment with brand voice
Supports facilitation ofsocial media engagement and updating content in local digital channels (e.g., hotel website, travel sites)
Assists with promotions campaign in F&B, weddings, spa, rooms and conferences through relevant digital and social media channels
Engages in proactive online reputation management by surfacing relevant guest comments (positive or negative) in social media channels and responds accordingly
Participates in the development of comprehensive PR plan per quarter along with agency

Fulltime

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Make a Real Difference—One Patient at a Time Now Hiring: Speech Therapist, Home...

Location

United States , Athens

Salary:

85000.00 - 105000.00 USD / Year

Aveanna Healthcare

Expiration Date

Until further notice

Requirements

Master’s degree in Speech-Language Pathology from an ASHA accredited college/university
Current and unrestricted SLP license to practice in the state of practice
Current CPR certification
One (1) year of recent experience as a Speech Language Pathologist in an acute care setting
Valid CPR, Drivers License and Proof of Automobile Insurance
As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

Job Responsibility

Provide Speech Therapy services as prescribed by the physician
Follow policies and procedures and conforms to all applicable patient care standards, licensure regulations and state laws
Provide a written evaluation defining Speech Therapy needs, goals and expected outcomes in conjunction with referring physician's Plan of Treatment
Provide a written Plan of Care for Speech Therapy goals and outcomes
Maintains the plan of care for assigned patients according to identified Speech Therapy goals and outcomes
Participate in coordination of services (including discharge planning), with health care team, physicians, parent/guardians, nurses, and others
Maintain patient and company confidentiality
Maintain effective communication between staff, health care team members, and family
Serves as a resource consultant for clinical staff
Provide physicians and Aveanna with written evaluation of patient's needs, goals, and progress.

What we offer

401(k) with company match
Health, dental, vision, life, and pet insurance
Mileage reimbursement and cell phone allowance
Generous PTO, sick time, and paid holidays
Inclusion Day
Float Day
Up to 8 Hours of Paid Volunteer time yearly
No-Cost Employee Assistance Program (EAP)
Robust DEI company program
Tuition discounts and reimbursement

Fulltime

New

Welfare Support Officer

We are looking for a compassionate and driven Welfare Support Officer to join ou...

Location

United Kingdom

Salary:

27414.50 - 27514.50 GBP / Year

360 Resourcing Solutions

Expiration Date

Until further notice

Requirements

Strong communication skills (verbal and written)
Excellent interpersonal and customer service skills
Ability to handle sensitive situations with empathy and professionalism
Strong organisational and time management abilities
High attention to detail and accuracy
Ability to prioritise workload and meet deadlines
Proactive and self-motivated with a positive attitude
Comfortable working independently and as part of a team
Experience using Microsoft Office 365 (Excel, Word, PowerPoint, Teams)
Ability to quickly absorb information and make sound decisions

Job Responsibility

Provide tailored, case-by-case support to vulnerable customers (e.g. mental health conditions, serious illness, disabilities)
Handle inbound and outbound calls with empathy, professionalism, and efficiency
Manage welfare referrals and ensure all cases are handled in line with company policies
Establish sustainable payment arrangements where appropriate
Request and manage sensitive information in a respectful and non-intrusive manner
Signpost customers to relevant support organisations and debt advice services
Build strong relationships with external partners and internal stakeholders
Ensure compliance with relevant standards (e.g. PCI DSS, vulnerability policies)
Support quality assurance, call audits, and continuous improvement initiatives
Assist with projects, customer journey improvements, and cross-team collaboration

What we offer

Hybrid working model
Healthcare cash plan
Lifestyle benefits including retail, travel, and wellbeing discounts
Life insurance (Death in Service)
25 days holiday plus bank holidays
Cycle to work scheme
Apprenticeship and upskilling opportunities

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Appeals and Grievances Clinical Specialist

Healthfirst

Location:
United States , New York City ▼
Lake Mary

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
February 21, 2026

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