- Molina Healthcare (San Antonio, TX)
- …directed by the Centers for Medicare and Medicaid Services. * Trains grievance and appeals staff, customer/member services department, sales, UM and other ... **Required Education** Associate 's degree or 4 years of Medicare grievance and appeals experience. **Required Experience** * 7 years' experience… more
- Molina Healthcare (St. Petersburg, FL)
- …Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and resolving ... and requirements established by the Centers for Medicare and Medicaid . This position will provide direct support to the...with state and federal regulations. Responsible for managing the Appeals and Grievance department inventories within the… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- Humana (Phoenix, AZ)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... and other sources of expertise. Medical Directors will learn Medicaid requirements, and will understand how to operationalize this...member population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- Humana (Salem, OR)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team… more
- Humana (Charleston, WV)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational… more
- Somatus (Mclean, VA)
- …+ Oversee new client pre-delegation audits, annual client audits, development of grievance and appeals workflow processes, and other regulatory requirements. + ... provides guidance and oversight to all lines of business including Commercial, Medicaid , Medicare, and Special Need Plans (SNPs). The Director, Quality will work… more
- BrightSpring Health Services (Louisville, KY)
- …to Member and Provider issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners ... and marketing presentations in accordance with applicable Centers for Medicare & Medicaid Services (CMS) and State guidelines and standards. + Conduct individual… more