- Commonwealth Care Alliance (Boston, MA)
- …lines or medical setting preferred - Prior experience with service authorizations, grievances and appeals , scheduling medical appointments preferred - Ability to ... work with multiple computer programs and phone systems at once Required Knowledge, Skills & Abilities: - Must be passionate about serving others and able to show empathy to distressed individuals - Skilled in problem solving by referencing departmental… more
- AmeriHealth Caritas (Philadelphia, PA)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the ... complaints/issues to management + Monitors to ensure that all problems with appeals / grievances presented by plan members/participants are resolved in accordance… more
- 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
- Sanford Health (Sioux Falls, SD)
- …governing appeals and grievance resolution. Lead and manage the end-to-end appeals and grievances process for all product lines, ensuring compliance with ... Oversee the intake, review, resolution, and documentation of all appeals , complaints, and grievances to meet regulatory...and documentation of all appeals , complaints, and grievances to meet regulatory and operational standards. Ensure all… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Customer Solution Center Appeals and Grievances (Temporary) Job Category: Management/Executive Department: CSC Appeals & Grievances Location: ... achieve that purpose. Job Summary The Supervisor, Customer Solution Center Appeals and Grievances is responsible for direct supervision and support of the team… 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 Location: ... safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty level … more
- Molina Healthcare (MI)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Molina Healthcare (Orem, UT)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
- Molina Healthcare (Columbus, GA)
- …with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals to the ... in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member… more
- Evolent (Nashville, TN)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Appeals and Grievances ** at Evolent is responsible for reviewing and processing ... or GED is required. + Minimum of 3 years' experience in an Appeals and Grievances role or comparable administrative role within a health plan, managed care… more
- Molina Healthcare (Austin, TX)
- …assist with research. + Determines appropriate language for letters and prepare responses to appeals and grievances . + Elevates appropriate appeals to the ... systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. +… more
- Molina Healthcare (Columbus, OH)
- …for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider ... responsible for the submission/resolution of member and provider inquiries or grievances . Ensures resolutions are compliant. + Assesses and audits business processes… more
- Molina Healthcare (Augusta, GA)
- …DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider ... + Responsible for the comprehensive research and resolution of the appeals from Molina members, providers and related outside agencies to ensure… 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 ... data and data related to the volume and complexity of the appeals and grievances submitted for resolution. **SUPERVISORY RESPONSIBILITY:** This position… more
- Elevance Health (Atlanta, GA)
- …and forwards to Medical Director for final review and decision. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + ... + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non-clinical… 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...and is dependent on court hearing schedules. The **Nurse Appeals - Litigation & Legal Support** is responsible for… more
- Elevance Health (Woodbridge, NJ)
- …an accommodation is granted as required by law._ The **Manager II Grievance & Appeals ** responsible for management oversight of grievances and appeals ... departmental units to investigate, resolve, and respond to grievances and appeals , manages inventory and production levels, and operational and plan risk,… more
- Motion Recruitment Partners (Birmingham, AL)
- …and passionate about making a difference in healthcare? We are seeking several Appeals and Grievances Coordinators for an onsite contract opportunity in ... skills will help drive impactful results as you navigate complex appeals and grievances processes. The ideal candidate will demonstrate initiative, a proactive… more
- Baylor Scott & White Health (Temple, TX)
- …and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal ... OF THE ROLE** Maintains data entry requirements for all complaints, appeals and grievances . Builds case files for each complaint, appeal and grievance, and… more
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