Appeals Referee Job Description Sample
Basketball Referee / Scorekeeper
Principal Responsibilities: We are looking for both Referees for our Dinky Dunkers program. Dinky Dunkers is a youth basketball league we offer here at the JCC for kids K-3rd. This is a fun, learning league for the kids. Games are on Sundays Scorekeeper needed for Mens adult basketball league- Games are on Thursday evenings
No certifications needed. Definitely need a good understanding of the general rules of basketball. Our primary goal is to make sure the kids are learning how to play the game and having fun doing so.
Founded in 1949, the Stroum JCC is dedicated to the enrichment of life for the Jewish and general community in the greater Seattle area. Located on Mercer Island, the J offers a variety of programs and activities for everyone from newborns to seniors.
The J is home to an Early Childhood School, a newly remodeled state-of-the-art auditorium, an upgraded Fitness Center, an indoor pool, and more. We host a variety of parenting classes and weekly Tot Shabbat programs for our youngest members and their parents. School-aged kids enjoy our Kidstown before and after school care, take sports and arts classes, spend their summers at SJCC Summer Camp, and become J Explorers.
Adults can join a sports league or a book club, attend events in the Kesher Garden, swim laps in the pool, or work out in our Fitness Center. Seniors learn to play bridge, join fitness classes, and attend our popular cultural arts events. Date Posted: 12/19/2017 Title: Basketball Referee / Scorekeeper
JCC:* Stroum Jewish Community Center
Location:* Mercer Island, WA
2017/18 Intramural (Im) Referee - Pool
2017/18 Intramural (IM) Referee - Pool Apply now
Job no:506347 Classification:Student Assistant A Grade:Student A Work type:Student Employee Administrative Unit:University of Alaska Anchorage School/Business unit:VCAS Athletics/Sport Center Location:Anchorage Categories:Athletics, Student Affairs/Services
The UAA Department of Athletics, located in the Alaska Airlines Center, is a diverse division designed to assist student-athletes in meeting their academic and athletic goals and to provide all UAA students the opportunity for physical development on the Anchorage campus. Duties: 100The Intramural (IM) Referee will be in complete charge of team intramural contests and will ensure the safety and integrity of all intramural games.
The IM Referee will ensure that all rules of play are followed and any rule violations are called.
Also assists with the set up and take down of all intramural games. Perform other duties as assigned by immediate supervisor, Associate Directors, and/or the Director of Athletics.Essential The University of Alaska Anchorage (UAA) Department of Athletics, located in the Alaska Airlines Center, is a diverse division designed to assist student-athletes in meeting their academic and athletic goals through the University's intercollegiate athletic program within the National Collegiate Athletic Association (NCAA) guidelines and to provide all UAA students the opportunity for physical development through the recreational sports program on the Anchorage campus.
The department's mission is to support the educational mission of the University of Alaska Anchorage; to protect and promote the safety, health and well-being of our student-athletes; guide and support our student-athletes in their pursuit of academic and athletic excellence; produce graduates and honorable citizens; and be actively engaged in our University community. Please visitwww.GoSeawolves.comto find out more about UAA Department of Athletics andwww.anchorage.netfor more about Anchorage, Alaska. To apply, please complete the application, include a cover letter, resume, and contact information for three (3) professional references.
Hourly Rate:$8.50 Job Duties: The Intramural (IM) Referee will be in complete charge of team intramural contests and will ensure the safety and integrity of all intramural games.
The IM Referee will ensure that all rules of play are followed and any rule violations are called.
Also assists with the set up and take down of all intramural games. Perform other duties as assigned by immediate supervisor, Associate Directors, and/or the Director of Athletics. Knowledge/Skills/Abilities:
Knowledge of rules for various team sports - basketball, hockey, volleyball, water polo and broom ball. Typical Education or Training: To be eligible for student employment at UAA, a student must: a. be enrolled in the university system with a minimum of six credit hours in the current semester of employment; or b. for employment between semesters, have successfully completed six or more UA credit hours in the preceding semester and demonstrate plans to enroll for six or more credit hours in the next semester; and c. not work hours which interfere with class attendance; and d. have at least a 2.0 cumulative grade point average.
NOTICE: Students must maintain enrollment and regular attendance for a minimum of at least 6 undergraduate credit hours or 6 graduate credit hours to be exempt from FICA (Social Security and Medicare) tax. A credit hour load below the minimum required for full-time student status will require the withholding of FICA tax (non-resident aliens on an appropriate visa who meet student employment criteria will continue to be exempt from FICA regardless of credit hour load). While in a student position, a student cannot hold any other type of simultaneous employment with the university. Advertised:09 Aug 2017Alaskan Daylight Time Applications close:
Position: Sports Referee Location:
Austin, TX Job Id: 236 # of Openings: 1 PRIMARY FUNCTION: Officiate at sporting events, games, or competitions, to maintain standards of play and to ensure that game rules are observed. HOURS AND PAY:
Part time hours will vary (12-20 hours a week) during the school year : 3:00pm to 7:00pm; Mon-Fri., with an occasional Saturday (trainings, tournaments, clinics, etc.) Out of school times (i.e. summer, winter break, spring break) will vary. Pay: $12-$12.50/hr (depending on experience) All employees working at a Club Location based in a school are expected to follow the calendar year of Austin Independent School District. Therefore, when the school is not in operation you will not have work unless specified by your supervisor. KEY ROLES (Essential Job Responsibilities): Ø Judge performances in sporting competitions in order to award points, impose scoring penalties, and determine results. Ø Signal participants or other officials to make them aware of infractions or to otherwise regulate play or competition. Ø Inspect sporting equipment and/or examine participants in order to ensure compliance with event and safety regulations. Ø Keep track of event times, including race times and elapsed times during game segments, starting or stopping play when necessary. Ø Assist with additional duties as needed.
Outdoor Ice Hockey Referee
Under the direct supervision of the Program Director, the Outdoor Ice Hockey Referee will call games and maintain structure for YMCA leagues. Also known as a referee. Scope of
Responsible for being prompt and professional during all games and program activities.
Interact with coaches, other sports officials / umpires, youth, parents and YMCA staff.
Enforce program rules and policies by maintaining constant surveillance of program participants.
Set up facility or equipment, store equipment, and secure facility upon completion of games/program (on an as needed basis).
Report equipment problems. Ensure safety of members/participants.
Respond to and report accidents and incidents to appropriate staff. + + Report any items that may provide a health or safety hazard to staff, members or guests to your supervisor or the person responsible for those items at your site.
Follow all policies and procedures related to keeping children safe in our facilities and programs, including those related to managing visitors and guests at our facilities.
Report any suspicious behavior and violation of policy and procedures to your supervisor.
Complete all child abuse prevention training as required.
- Support the YMCA’s mission and center operations as needed.
Minimum a high school diploma or equivalent.
1-3 years of sports officiating / umpire experience.
Must have a strong knowledge of the sport and league rules. ID: 2017-10287 Center: Elmhurst Street: 211 W. First St. Hours per Week: 15-20 Variable Schedule: varies External Company Name: YMCA of Metropolitan Chicago External Company URL: www.ymcachicago.org/careers
With award-winning facilities and spaces, technology, equipment, and services, EXOS connects people to the solutions they need and provides individualized plans based on time-tested fundamentals and research in order to help people take control of their health and performance. EXOS takes a unique approach to fitness center design, facility management, and training technology to create welcoming environments that facilitate healthy lifestyles. From business planning to operations, we use our decades of experience to drive member acquisition, engagement, and retention.
We know that the more engaging and effective a fitness center is, the more success it will have. It’s all about providing members with a positive experience and the tools they need to accomplish their goals. EXOS is seeking a Basketball Referee to join our team in Palo Alto, CA.
As our new Basketball Referee you will provide skillful officiating for the adult leagues, corporate leagues, and co-ed leagues offered onsite.
Current CPR/AED and First Aid certification
Previous experience coaching children’s basketball
- Previous experience with individual and small group instruction for all ages
Outstanding communication skills which include the ability to use clear and concise written and oral language in all aspects of professional interaction with players, their families, peers, and the larger community
At least one year successful league coordination experience
- Outgoing, enthusiastic personality and excellent communication skills Physical
Candidates applying for this position should be able to lift up to 50 pounds unassisted repeatedly throughout the workday.
Also, the physical requirements of this job require frequent walking around and demonstrating and assisting with exercise movements; bending, stretching, lifting, pushing, pulling and squatting are movements performed daily. EXOS is proud to be an affirmative action / equal opportunity employer. All qualified applicants will receive consideration without regard to race, creed, gender, marital status, sexual orientation, citizenship status, color, religion, national origin, age, disability, veteran status, or any other status protected under local, state, or federal laws.
EXOS provides reasonable accommodation to employees and applicants for employment who have disabilities. You may request reasonable accommodation, in writing, by reaching out to our HR department at : Attention : EXOS Human Resources, Accommodations 2629 E. Rose Garden Ln. Phoenix, AZ 85050 ID: 2017-8920 External Company URL: www.teamexos.com
bTitle: Referee* Department: ProgramandOperations Rep
AStatus: Non-Exempt* SupervisesOthers: NoGENERALPURPOSEOFJOB: Under thegeneralsupervisionofthe
SportsCoordinator,theRefereeisresponsibleforofficiating sportingevents,gamesandtournamentsatthemiddleschoollevel. TheRefereewillmaintain standardsofplayandensurethatthegamerulesareobserved. TheRefereeisexpectedto cooperatewith THINK Togetherstaff,coachesandother officialstodevelopapositiveself-image intheplayersandtoprovidea goodrolemodelforallstudentparticipants. ESSENTIALDUTIESANDRESPONSIBILITIES: ProgramDuties: * Officiatesportingevents,gamesandtournamentsfor varioussportsseasons(e.g.,flag football/volleyball,basketballandsoccer)throughouttheacademicyear
Signalparticipantsorotherofficialstomakethemawareofinfractionsorto otherwise regulateplayorcompetition
Maintainsa safeandpositiveplayingenvironmentandencouragescooperativegameplay andsportsmanship
Attendrefereetrainingsandmeetingsasrequestedto developrefereeingskillsandsport rules AdministrativeDuties: * Maintaincommunicationbetweenprogramstaff,regionalstaff,coachesandplayers
Collectandmaintainrelevantpaperworkincludingdaily,weekly,andmonthlyschedules EDUCATIONand/orEXPERIENCE: * Atleastsixmonthsexperienceworkingwitha groupof10ormorestudentsina classroom,afterschool,orrecreationenvironment;preferenceforexperienceatthe middleschoollevel
Knowledgeofthespecificsport(s)andabilityto facilitatea safeandlearningsporting experience
RequiredabilitytospeakandwriteStandardEnglishappropriateina publicschool setting
SatisfactoryTBskintest COMPUTER& EQIUPMENTSKILLS: Wordprocessing Usetypicalofficeequipment E-mail Internetsoftware WORKENVIRONMENT:AMOUNTOF TIME NONE UNDER1/3 1/3– 2/3 OVER2/3 Wetorhumidconditions(non-weather) X Worknearmovingmechanicalparts X Workinhigh,precariousplaces X Fumesorairborneparticles X Toxicorcausticchemicals X Outdoorweatherconditions X Extremecold(non-weather) X Extremeheat(non-weather) X Riskofelectricalshock X Workwithexplosives X Riskofradiation X Vibration X Howmuchnoiseis typicalfortheworkenvironmentof thisjob? * Moderatenoise(examples:typicalschoolnoisewithchildrenatplay) *P
YSICALDEMANDS:AMOUNTOFTIME NONE UNDER1/3 1/3– 2/3 OVER2/3 Stand X Walk X Jog X Sit X Usehandstofinger,handle,orfeel X Reachwithhandsandarms X Climborbalance X Stoop,kneel,crouch,orcrawl X Talkorhear X Tasteorsmell X Visualefficiency X Thisjobrequiresthatweightbelifted/pulledorforcebeexertedasindicatedinthe boxesbelow:AMOUNTOFTIME NONE UNDER1/3 1/3– 2/3 OVER2/3 Upto10pounds X Upto25pounds X Upto50pounds X Upto100pounds X Morethan100pounds X Doesthisjobhaveanyspecialvisionrequirements? * Closevision(clearvisionat20inchesorless)- ViewingComputerScreen ADDITIONALINFORMATION: * Mustbewillingtoworksomeeveningsandweekends
Refereesarerequiredtoprovideavailabilitythroughouttheregularseasonandthe Saturdaytournament Acknowledgment: I, (print name)__ __ have read and understandtheabovejobdescription andagreetocomplywithandbesubjecttoitsconditions. Iunderstandthatthe Organizationreservesthe rightto delegate,remove,expandor changeany andall responsibilitieslistedaboveandwillinformmeofanysuch change.Inadditionto thejob dutiesaboveI agreeto abidebythe Organizationpoliciescontainedinthe employeehandbook.I certifythat
Iamabletoperformthe jobdutieswithorwithoutanaccommodation. EmployeeSignature:_ Date: __ SupervisorSignature_: Date: __ Posted On: 01/09/2018 Requisition ID: 1541 Job Class: Service Workers
Grievance & Appeals Coordinator II
Description: Position Purpose: Analyze and resolve verbal and written claims and authorization grievance/appeals from providers and members. Resolve all State inquires related to complaints, grievances and appeals.
Review and process member and provider grievances and appeals within federal, state and organizational regulations and policies and procedures + Review claim grievance for reconsideration and either approve/deny based on determination level or prepare for medical review presentation. Prepare cases for medical review as necessary + Review and determine if claim grievance includes a potential quality or access issue + Collaborate with subject matter experts within the organization to obtain benefit and/or clinical opinions/interpretations of complex cases + Serve as liaison between member, provider regulatory agencies and internal staff. Correspond with key individuals regarding grievance and appeal decisions.
Act as subject matter expert regarding grievances and appeals.
Lead Appeals and Grievance Committee
Education/Experience: Bachelor s degree in related field or equivalent experience. 2 years of claims, contracting, or related experience in a managed care environment. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Job:Health Insurance Operations
Organization:Health Net of California
RN Clinical Appeals
Under limited supervision, manage the clinical review of provider and member appeals for all product lines to ensure timely resolution within required turnaround times, utilizing member contract or EOC, published clinical criteria, medical policy or Medicare coverage criteria, as applicable. Perform post-payment quality audit of post-service clinical review. Required Experience:
Three years clinical (to include medical/surgical inpatient and/or outpatient care or specialty care)
Two years coding (to include physician procedural coding and/or inpatient and outpatient commercial and Medicare coding)
Two years medical claims reviews or medical record audit Required Education:
Bachelor’s degree in Nursing Required Certifications/Licenses:
Valid Idaho Registered Nurse License Required Knowledge, Skills and Abilities (KSAs): Knowledge of:
Medical record review
Claim review processes and workflow
Clinical criteria and medical policy
Diagnosis/Procedure coding guidelines
- Center for Medicare and Medicaid Services (CMS)
Interpersonal, verbal, and written communication
Independent & critical thinking
Microsoft Word – Basic
Microsoft Excel – Basic
Microsoft Outlook – Basic
Personal computer and keyboard Ability to:
Schedule time effectively
Handle multiple projects simultaneously and prioritize work appropriately
Work well in a highly integrated team environment
Handle diverse activities on a daily basis
Communicate with diverse audiences PREFERRED QUALIFICATIONS: * Certified Professional Coder (CPC) and/or Certified Professional Coder – Hospital (CPH)
Prior Blue Cross of Idaho experience as a pre-service or post-service clinical reviewer
Knowledge of Facets claim and inquiry review applications Reports To: VP, Service Operations Pay Grade: 16 Internal Posting Date: 01/09/2018 - 09/16/2018 External Posting Date: 01/09/2018 - Until Filled
Job ID #:* 1549 Location: Meridian, ID (Corporate Headquarters)
Job Category:* Nursing
Education Required:* Bachelors Degree
Employment Type:* Full Time
Experience Required:* 3 - 5 Years
Pharmacy Technician I Prior Authorizaton & Appeals
Job Description This position will be responsible for performing non-clinical activities and functions in accordance with policies and procedures under the supervision of the PA Supervisor, PA Manager, and Director of Clinical Operations. The primary purpose of this position is to support the processes involved with entering prior authorizations for CVS Health contracted clients. AMNHC
Required Qualifications 1+ year Healthcare Industry experience (hospital, managed care, physician office, PBM, etc). Problem solving skills, analytical ability. Strong written communication skills and interpersonal skills.
Detail oriented with excellent organizational skills. Preferred knowledge of prescription drug products, dosage forms, and usages. Medical/Pharmacy terminology background. Ability to type 25-30 wpm.
Preferred Qualifications 1+ year experience in Data Entry. 1year of Microsoft Office Suite experience.
Education High School Diploma or GED required.
Business Overview CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers.
What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy.
Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers. CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law.
CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster:
EEO IS THE LAW at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf and EEO IS THE LAW SUPPLEMENT at https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health at mailto:EEO_AA@CVSHealth.com CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process. For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609.
For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/
Nurse, UM Appeals
$2,500.00 Sign on bonuses for experienced UM Nurses will be offered
Nurse, UM Appeals
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
Position Summary The Grievance and Appeals Nurse is responsible for handling the clinical components of the grievance and appeals process for Valence Health and applicable clients. The position ensures that clinical grievances and appeals are processed in accordance with federal and state laws and regulations, contract provisions, accreditation standards, and internal policies and procedures.
Essential Functions Conducts Standard and Expedited Medical Appeals Processes in compliance with applicable federal and state regulatory requirements, contracts, and national accreditation standards.
Gathers and provides documentation and research outcomes within required time frames to Clients who manage their own appeals.
Ability to interpret and operationalize multiple regulatory requirements and differences in each.
Ability to multitask and respond quickly and accurately to issues and concerns for members and internal departments.
Collaborates with appropriate staff to resolve member and provider clinical Grievances; formulate improvement measures and responses; prepare written correspondence to member and others as required.
Other duties as assigned
Education and Experience Licensed registered nurse (current and unrestricted) OR licensed vocational/practical nurse (current and unrestricted)
Associate or Bachelor Degree in Nursing required; Bachelor Degree preferred
Minimum of three years of direct clinical patient care
Minimum of three years of experience with medical management activities in a managed care environment
Knowledge of managed care principles, HMO and Risk Contracting arrangements.
Knowledge of CMS (Medicare/Medicaid) regulations and requirements
Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual)
Strong interpersonal, oral and written communication skills.
Possess basic computer skills Evolent Health is an Equal Opportunity/Affirmative Action Employer
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