- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los ... that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage process… more
- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the general direction of the Manager , Appeals and Grievances the Supervisor, ... and provide leadership for the daily operations of the Appeals and Grievances department. The supervisor represents...ensure all cases are processed timely. + Work with Manager to ensure that employees have the requisite information… more
- Point32Health (MA)
- …at Point32Health (https://www.point32health.org/) . **Job Summary** Under the direction of the A&G Manager , the Appeals & Grievances QA Auditor audits the ... audit findings and identifies areas of opportunity for the A&G ( Appeals and Grievances ) department. Understands department, segment, organizational strategy… more
- Molina Healthcare (St. Petersburg, FL)
- …apply state level requirements to meet contract and regulatory expectations. * Establishes Appeals & Grievances department policies and procedures in line with ... and interprets trends and prepares reports that identify root causes for Appeals , Grievances , and Provider Disputes. Recommends and implements process… more
- Molina Healthcare (San Antonio, TX)
- …and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and ... organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving... and grievance processing/resolution, including 2 years in a manager role. * Experience reviewing all types of medical… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances...clerical/administrative responsibilities at the discretion of the Director or Manager . * Providing administrative assistance in support of the… more
- Elevance Health (Durham, NC)
- …an accommodation is granted as required by law._ The ** Manager II Grievance/ Appeals ** responsible for management oversight of grievances and appeals ... ** Manager II Grievance/ Appeals ** **- Claims Support**...departmental units to investigate, resolve, and respond to grievances and appeals , manages inventory and production… more
- State of Colorado (Denver, CO)
- CDOC Mid Level Provider / Nurse Manager - (DENVER) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5019611) Apply CDOC Mid Level Provider / ... Nurse Manager - (DENVER) Salary $8,788.00 - $12,302.00 Monthly Location...departments; + Responsible for budget, reporting, conflict resolution, inmate grievances , and maintaining a comprehensive inmate medical record; +… more
- CUNY (Brooklyn, NY)
- …Rules); tracking student conduct reports; coordinating the student conduct process, grievances , and appeals . + Oversee the Faculty Student Disciplinary ... Manager of Student Advocacy and Accountability (HEA) **POSITION...intervention student support service process, the resolution of student grievances , appeals , and complaints, and the utilization… more
- State of Colorado (CO)
- CDOC - Human Resources Specialist V (Human Resources Manager ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4994350) Apply CDOC - Human ... Resources Specialist V (Human Resources Manager ) Salary $7,610.00 - $12,177.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA 3310 HRS V 7.2025… more
- Transdev (North Las Vegas, NV)
- …abreast of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Work with Internal and outside ... Labor Relations Manager The Labor Relations Manager provides...the grievance process and provide comprehensive responses to complaints, grievances , and arbitrations that support the Company's decision and… more
- Sacramento County (Sacramento, CA)
- Human Services Division Manager Range A/B Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/2234944) Apply Human Services Division Manager ... $12,042.50 - $14,636.88/month Under executive direction, the Human Services Division Manager plans, coordinates and administers a human services division comprised… more
- CHS (Clearwater, FL)
- …client trust. * Investigates and participates in formal responses relating to complaints, grievances and appeals received by or applicable to PAS. Participates ... **Overview** **Claims Manager ** **Servicing** **Health Insurance Policies or Benefits** **Summary:**...stated coverage. Join Premier Administrative Solutions as a Claims Manager and lead our Claims Department in delivering exceptional… more
- Roper St. Francis (Charleston, SC)
- …legal field, customer service or healthcare preferred. Prior experience working with grievances and appeals strongly preferred. Knowledge of RSFH organizational ... Summary** **:** The Patient Relations & Legal Coordinator aids in complaints and grievances management as well as legal matters to include coordinating with outside… more
- Elevance Health (IN)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + BA/BS degree ... **LTSS Service Coordinator (Case Manager )** **Location:** Seeking candidates to work in Bartholomew...and direct, hands-on engagement. The **LTSS Service Coordinator (Case Manager )** is responsible for conducting service coordination functions for… more
- Elevance Health (Mason, OH)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... **LTSS Service Coordinator (Case Manager )** **Hiring statewide across Ohio** **Location** : This...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Centene Corporation (Sacramento, CA)
- …+ Prior experience with issue management in Call Center environment and/or Appeals & Grievances + Reporting knowledge **Education/Experience:** Bachelor's degree ... to deliver defined requirements and meet company strategic objectives. The Project Manager II is primarily remote with 10% travel expectation. Candidates must reside… more
- State of Colorado (Sterling, CO)
- …plans, and conducts performance evaluations; resolves informal staff and/or inmate grievances . Assigns tasks, monitors and inspects work progress and ensures ... inmate hours and pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and creates real life… more
- Humana (Springfield, IL)
- … Manager , and Medical Director) and departments to address and resolve member grievances and appeals . + Oversees the interface with the Enrollment Broker ... referrals, self-referral services, preventive and enhanced services, and member grievances and appeals procedures + In close coordination with other key staff,… more
- State of Colorado (Aurora, CO)
- …Individualized Program Instruction/Tutoring, Multi-Disciplinary Staffing, Responding to Offender Grievances and Resolving Offender Issues, Offender Housing Placement ... classification hearings, ICC, Multi disciplinary staffing, vetting responses to offender grievances etc. Therefore, experience as an entry level officer and clerical… more