• Senior Specialist, Appeals

    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
    Molina Healthcare (06/25/25)
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  • Coordinator - Appeals & Grievances

    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
    Trinity Health (06/11/25)
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  • Contractual Reviewer - Senior

    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
    Independent Health (06/30/25)
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  • Senior Medical Director - Sharp…

    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
    Sharp HealthCare (04/20/25)
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  • Senior Human Resources Analyst - Multiple…

    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
    City and County of San Francisco (04/16/25)
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  • Senior Employee and Labor Relations…

    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
    Tufts Medicine (07/09/25)
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  • Senior Counselor, Juvenile Hall, Juvenile…

    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
    City and County of San Francisco (07/04/25)
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  • Medical Director - Sharp Health Plan…

    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
    Sharp HealthCare (05/18/25)
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  • Member Engagement, Sr Specialist (Remote…

    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
    Molina Healthcare (06/29/25)
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  • Medical Director, Behavioral Health…

    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
    Centene Corporation (05/04/25)
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  • Director, Quality

    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
    Somatus (05/13/25)
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  • Associate Dean for Faculty Affairs Open…

    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
    University of Colorado (06/28/25)
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  • Claims Manager

    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
    CHS (05/09/25)
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  • Online Graduate Program Advisor

    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
    University of Colorado (07/10/25)
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  • Attorney II - Labor and Employment

    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
    City of Jacksonville (07/10/25)
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  • Labor Attorney

    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
    MTA (05/31/25)
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  • Human Services Division Manager Range A/B

    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
    Sacramento County (07/08/25)
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  • Technical Applications Manager II

    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 (07/08/25)
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  • Compliance Advisor II

    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
    LA Care Health Plan (07/06/25)
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  • Key DSO Dental Account Manager

    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
    Guardian Life (06/18/25)
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