- Molina Healthcare (Davenport, IA)
- …research and resolution of the complex or escalated and high dollar appeals , grievances , and/or complaints from Molina members, providers and related ... outside agencies. + Research claims appeals and grievances using support systems to...determine appeal and grievance outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates… more
- Trinity Health (Columbus, OH)
- … and Grievance Coordinator is responsible for the processing and resolution of appeals , grievances and disputes from members and providers **What You Will ... preparation of case files and review with clinical colleagues. + Screen all incoming grievances , appeals and provider claim dispute to ensure they are within… more
- Independent Health (Buffalo, NY)
- …timely and consistent review and investigation of provider and/or member complaints and/or appeals . The Contractual Reviewer- Senior will be required to rely on ... to collaborate with multiple departments and associates to properly investigate appeals /complaints. The Contractual Reviewer- Senior will also be responsible for… more
- Sharp HealthCare (San Diego, CA)
- …for the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for ... to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify… more
- City and County of San Francisco (San Francisco, CA)
- …City and County of San Francisco is looking to bring on board multiple Senior Human Resources Analysts to help departments in hiring, supporting, and retaining a ... growth, the City offers excellent benefits that include: competitive salaries; medical , dental, and vision insurance; defined benefit retirement plan; deferred… more
- Tufts Medicine (Boston, MA)
- Tufts Medical Center is a world-renowned academic medical center that has been providing exceptional care across New England for over two centuries. Our ... School of Medicine and a leading research institution that conducts game-changing medical and health policy research. **Location: Hybrid at Tufts Medical … more
- City and County of San Francisco (San Francisco, CA)
- …of redemption and helping people to succeed. Under general direction, the 8322 Senior Counselor, Juvenile Hall oversees the operation, and maintenance of a juvenile ... cases; may be assigned to investigate and resolve juvenile grievances . 7. Reviews and approves all youth discipline along...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- Sharp HealthCare (San Diego, CA)
- …policy as needed. + Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify trends ... **Shift End Time** California Physicians and Surgeons License - Medical Board of CA; Doctor of Medicine (MD) **Hours**...in grievances . Supervises the process for identifying Potential Quality Issues.… more
- Molina Healthcare (Detroit, MI)
- …Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the ... Molina Healthcare of Michigan is hiring for a Member Engagement, Senior Specialist. This role is primarily remote with some travel for local events in or near the… more
- Centene Corporation (Olympia, WA)
- …Conducts concurrent and retrospective reviews of claims and appeals , and resolves grievances related to medical quality of care. + Leads, develops, directs ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Somatus (Mclean, VA)
- …the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional ... the Regulatory and Accreditation Team to ensure compliance with audits, complaints/ grievances , and adherence to contractual obligations and Service Level Agreements… more
- University of Colorado (Aurora, CO)
- …Rank-Associate Professor and Professor** **Description** **University of Colorado Anschutz Medical Campus** **Department: School of Medicine, Office of the Dean, ... on campus & community committees as directed by the Senior Associate Dean for Faculty and CWO. + Oversee...+ Address faculty concerns regarding professionalism, grievance procedures, and appeals processes and serve as a neutral party and… 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 ... service, claims administration, is where submissions for payment/reimbursement/sharing from medical providers and covered individuals are reviewed, subject to cost… more
- University of Colorado (Boulder, CO)
- …with questions or concerns. Assists students with problem-solving and campus resources. Advances appeals or grievances to the senior program manager as ... and processes degree conferrals at the end of every session. + Assists the Senior Online Program Manager in sending regular messages through CRM system and unlinked… more
- City of Jacksonville (Jacksonville, FL)
- …Description This is a Labor and Employment Attorney position that reports to a senior attorney. The primary purpose of this position is to provide labor and ... assigned clients. Work is performed under the direction of a managing or senior attorney and is reviewed through conferences, inspection of work product and… more
- MTA (New York, NY)
- …involving labor relations issues such as contract interpretation, disciplinary matter, medical appeals , Civil Service Law and matters affecting Authority-wide ... Civil Service Law, matters affecting authority-wide policy and procedures, and involuntary medical leave. Handles complex contractual grievances that may have… more
- Sacramento County (Sacramento, CA)
- …flexible spending account options for dependent care and unreimbursed dental and/or medical cost; and an employee assistance program (EAP). GENERAL BENEFITS: Most ... a pre-tax basis via payroll deduction, to pay for medical , dental or dependent care expenses. + DEPENDENT CARE...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more
- LA Care Health Plan (Los Angeles, CA)
- …Functional knowledge of Membership Eligibility and Enrollment, Member Maintenance, PCP assignment, Appeals and Grievances preferred. EDI 5 years of EDI Domain ... Summary The Technical Application Manager II reports to the Senior Manager Information Technology IT Solutions Delivery. This role...Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical , Dental and Vision + Wellness Program + Volunteer… more
- LA Care Health Plan (Los Angeles, CA)
- …care setting. Experience in health care auditing and monitoring (preferably in Appeals , Grievances , Quality Improvement, Utilization Management (UM) and so ... Care's risk to state/federal sanctions and fines- communicate required action to senior management/Board of Governor (BoG), Plan Partner staff. 2. Internal audit… more
- Guardian Life (Holmdel, NJ)
- …contact for all assigned DSOs. Respond to provider inquiries, concerns, complaints, appeals and grievances within assigned timeframes. Collaborate across teams ... manage contracts and financial reimbursement rates with DSOs + Make presentations to senior -level management of DSOs + Identify and report to leadership team on… more
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