- Molina Healthcare (South Charleston, OH)
- …Manages staff responsible for the submission/resolution of member and provider inquiries, appeals and grievances for the Plan. Ensures resolutions are compliant. ... tracking system of correspondence and outcomes for provider and member appeals / grievances ; oversees monitoring of each member submission/resolution to ensure… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances ... net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G)...appeals issues, preferably in a managed care or Medicaid Health Plan environment and/or public services or public… more
- CareFirst (Baltimore, MD)
- …mandates. Directs the activities and serves as a resource for associates within the Appeals and Grievances Department for Government Programs. We are looking for ... training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in...data related to the volume and complexity of the appeals and grievances submitted for resolution. **SUPERVISORY… more
- Elevance Health (Charlotte, NC)
- …providers, and regulatory entities, and serves as a subject matter expert for appeals , grievances , and quality of care issues. + Key responsibilities: serves ... **Nurse Appeals - Litigation & Legal Support** **Location:** North...is strongly preferred. + Basic knowledge of Medicare and Medicaid guidelines is preferred. + Ability to, and comfortability… 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 ... the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the...assigning all incoming appeals and grievances… more
- Elevance Health (Norfolk, VA)
- …delegated Healthcare Vendors (Vision, Dental, Transportation) strongly preferred + Experience with Medicaid and Medicare grievances and appeals processes + ... **Vendor Implementation Manager ** **Hybrid 1:** This role requires associates to...enhancement and issue management for multiple states and for Medicaid and Medicare lines of business. **How You Will… more
- CVS Health (Springfield, IL)
- …Integrated Product Experience + Experience with Part D Coverage Determination, Appeals and Grievances and/or Formulary Administration regulatory requirements and ... audit management + Experience with Part C & D reporting requirements + 3+ years serving as project lead + Adept at problem solving and decision making + Experience dealing with state or federal regulators + Excellent written and verbal communication skills and… more
- Molina Healthcare (Detroit, MI)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
- Commonwealth Care Alliance (Boston, MA)
- …and supports, and community supports as approved + Supports escalation of member grievances and appeals + Supports the procurement of network providers and ... across various locations. This position reports to the CIC APC Clinical Manager . **Supervision Exercised:** No, this position does not have direct reports.… more