- Optum (San Juan, PR)
- …in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. This position will communicate with appropriate parties ... regarding appeals and grievance issues, implications and decisions. In addition,...decisions. In addition, analyze and identifies trends for all appeals and grievances. Primary Responsibilities: Manage and resolve healthcare… more
- SUNSHINE ENTERPRISE USA LLC (Orange, CA)
- Job Description Grievance & Appeals Nurse Specialist At Sunshine Enterprise USA, we're not just a company; we're a community of dedicated professionals committed to ... employees, explore our current job opportunities below. Job Title: Grievance & Appeals Nurse Specialist Department(s): Grievance and Appeals Resolution Services… more
- Crystal Stairs (Los Angeles, CA)
- …status, sexual orientation, or military status, in any of activities or operations. Appeals - Hearing Officer ( Appeals Hearing Specialist) Location: Los Angeles ... for all families certified. The position performs research, and a review of appeals matters and works with staff and families to determine program compliance as… more
- Jackson Lewis PC (Cleveland, OH)
- …in the US News - Best Lawyers(R) "Best Law Firms". Job Summary The Billing Appeals Specialist will represent the accounting department and work as a key member of ... the appeals team while providing full-service support to attorneys on...will liaise with attorneys and staff to make sure appeals are submitted accurately and in a timely manner,… more
- MedStar Health (Baltimore, MD)
- Candidates with previous Utilization Review or Denials/ Appeals experience preferred General Summary of Position Responsible for coordinating and monitoring the ... denial management and appeals process. Combines clinical, business and regulatory knowledge and...the orientation of new staff regarding the denials and appeals process. May manage the department in the Managers… more
- Virginia Jobs (Richmond, VA)
- Title: Legal Secretary, Criminal Appeals State Role Title: Legal Secretary Hiring Range: Commensurate with Experience and Qualifications Pay Band: UG Agency: ... Attorney General & Dept of Law Location: Office of the Attorney General Agency Website: https://www.oag.state.va.us/ Recruitment Type: General Public - G Job Duties This position provides a full range of legal and administrative support to three to four… more
- Academy Art Museum (Easton, MD)
- …This includes overseeing major donor engagement, membership strategy, annual appeals , grants management, capital campaigns, and special fundraising events. The ... and alumni, ensuring consistent stewardship. Lead and execute annual appeals , including campaign strategy, donor segmentation, and personalized outreach. Guide… more
- US Courts (Washington, DC)
- Summary The Legal Division of the Office of the Clerk, US Court of Appeals for the DC Circuit, will have an opening in August or September 2025 for a highly ... recommend to the court the disposition of substantive and procedural motions, appeals decided without oral argument, and emergency matters. Staff attorneys conduct… more
- Randstad (Worcester, MA)
- …requirements and individual expectations. This role serves to administer the appeals and grievance process as outlined in handbooks, departmental policies, and ... standards. This role is responsible for triaging and assigning all incoming appeals and grievances and will also provide administrative support to the department.… more
- Alachua County Board of County Commissioners (Gainesville, FL)
- …Dependency and Indemnity Compensation, Burial and Memorial Benefits, Debt Waivers, Appeals , Medical Care, Educational Benefits, Life Insurance, Home Loan Guaranty, ... and sicknesses using Veterans Laws, Rules and Regulations. Prepares appeals of cases to be sent to the Board...cases to be sent to the Board of Veterans' Appeals in Washington, DC; Prepares appeals for… more
- CERiS (Fort Worth, TX)
- …FUNCTIONS AND RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry ... audits. Utilize applicable tools and resources to complete internal audits and/or appeals . Timely completion of internal audits and/or appeals . Attends Clinical… more
- Baltimore County, MD (Towson, MD)
- …the District of Maryland and courts in other jurisdictions. Prosecute and defend civil appeals on behalf of the Baltimore County government in the Maryland Court of ... Special Appeals , the Maryland Court of Appeals , the United States Court of Appeals (any Circuit), and the Supreme Court of the United States. Prepares the… more
- Kaiser Permanente (Denver, CO)
- …review benefit exceptions, visiting member claims, self-funded claims reviews, appeals , to include verifying information, spreadsheet knowledge, locating the ... PT, OT, and ST). Review cases to determine if benefit exception applies. Appeals and escalated issues for members and providers: Receive CEP (customer experience… more
- Vinfen (Cambridge, MA)
- …collections. Assists in developing and modifying tracking and reporting process for denials, appeals status and appeals results. Ensures that all denials are ... tracked and the appeals are monitored accordingly. Performs other duties as required. Why Vinfen? We are committed to you! We offer great training, great benefits,… more
- UnitedHealth Group (Metairie, LA)
- …Care Management team and Clinical Coverage Review team (prior authorization), Appeals and Grievances, Optum Behavioral Solutions, Optum Physical Health, OptumRx and ... other shared services teams Grievances and Appeals - The CMO maintains an active liaison with...- The CMO maintains an active liaison with UnitedHealth Appeals & Grievances team and is responsible for representing… more
- Community Care Network (Rutland, VT)
- …Director will also act as the lead for complaints, grievances, and appeals , and support Agency responses to legal inquiries or regulatory investigations. ... compliance topics for new hires and ongoing education. Complaints, Grievances and Appeals Serve as the Agency's primary point of contact for complaints, grievances,… more
- The Legal Aid Society (New York, NY)
- …low-income clients before the US District Courts and the US Courts of Appeals to safeguard immigrants' constitutional rights and ensure that immigration laws are ... litigation before federal district courts and US Courts of Appeals for the Second and Third Circuits, including habeas...immediately seek admission to the United States Court of Appeals for the Second and Third Circuits and US… more
- Telligen (Boston, MA)
- …individual responsibility for the performance of medical necessity reviews, including appeals and peer-to-peer reviews of assigned contracts. You will support ... Serves as the medical expert with peer review and appeals processes. Works closely with assigned teams to meet...as a technical expert on the peer review and appeals processes. Represents Telligen policies and procedures to medical… more
- CACI International, Inc. (Birmingham, AL)
- …the court. Manages technical documents specific to the 11th Circuit Court of Appeals , and completes variable aspects of recurring legal documents in conformance with ... rules governing their style and format. Provides assistance to attorneys in appeals preparation by performing duties such as independently compiling trial notebooks… more
- City of Doral, FL (Miami, FL)
- …must be eligible for certification by the Miami-Dade County Board of Rules and Appeals as specified in Chapter 8 of the Code of Miami-Dade County. License must ... certificate from the Miami-Dade County Board of Rules and Appeals . Must have a valid motor vehicle operator's license....certificate from the Miami-Dade County Board of Rules and Appeals ? Yes No 03 Do you possess a State… more
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