- 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
- Banner Health (AZ)
- **Department Name:** Grievances & Appeals **Work Shift:** Day **Job Category:** General Operations **Estimated Pay Range:** $20.01 - $30.01 / hour, based on ... our innovation to employment settings by including remote and hybrid opportunities. ** Appeals and Grievances Management** + Review, research, investigate, and… more
- Centene Corporation (Raleigh, NC)
- …and authorization appeals from providers and pursue resolution of formal grievances from members. + Gather, analyze and report verbal and written member and ... provider complaints, grievances and appeals + Prepare response letters for member and provider complaints, grievances and appeals + Maintain files on… more
- TEKsystems (Long Beach, CA)
- …structure and maintains current and additional information as it relates to Grievances and Appeals services. Utilizes department desktop procedures, workflows, ... High School Diploma, Required 2 years of experience within grievances and appeals in a healthcare setting Experience Level Expert Level #westpriority25… more
- CoreCivic (Watonga, OK)
- …a responsibility to better the public good. We are currently seeking a **Grievance Coordinator ** who has a passion for providing the highest quality care in an ... making an impact for the people and communities we serve. The Grievance Coordinator oversees the inmate/resident grievance process and ensures that both informal and… more
- Elevance Health (KS)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals and state audits. **Minimum Requirements:** + Requires BA/BS ... **LTSS Concierge Coordinator ** **Location: This position is fully remote but...is granted as required by law._** The **LTSS Concierge Coordinator ** is responsible for supporting the LTSS Coordinator… more
- Elevance Health (Columbus, OH)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals and state audits. **Minimum Requirements:** + Requires BA/BS ... **LTSS Concierge Coordinator (Case Manager)** **Hiring statewide across Ohio** **This...and supports, and psychosocial needs. The **LTSS Transition Concierge Coordinator ** is responsible for supporting the LTSS Transition … more
- Elevance Health (Tallahassee, FL)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... **LTSS Service Coordinator (Bilingual in Spanish/English)** **Schedule:** Monday-Friday 8am-5pm **Location**...is granted as required by law._ The **LTSS Service Coordinator ** is responsible for conducting service coordination functions for… more
- Elevance Health (Worthington, OH)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... **LTSS Service Coordinator (Case Manager)** **Hiring statewide across Ohio** **Location**...services and supports, and psychosocial needs. The **LTSS Service Coordinator ** is responsible for managing service coordination for a… more
- Cedars-Sinai (Beverly Hills, CA)
- …the payor + Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate ... Initiative for Hiring. **Req ID** : 12511 **Working Title** : RN Care Coordinator - Inpatient Specialty Program - 8-Hour Days - $5,000 Hiring Incentive!!… more
- Justice, Bureau of Prisons/Federal Prison System (Washington, DC)
- …Some examples of this qualifying experience are: GS-13: Experience investigating grievances submitted as administrative remedy appeals , regarding Women and ... Special Populations policies and procedures. Experience implementing and/or evaluating evidence-based programs for women or members of other special populations (aging offenders, parents or pregnant inmates, inmates living with disabilities, and/or veterans);… more
- Highmark Health (Dover, DE)
- …through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical ... staff. + Other duties as assigned or requested. **QUALIFICATIONS:** **Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + Pharmacy technician certification… more
- State of Colorado (Denver, CO)
- …professional development training (as available). Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, ... interventions for all youth. Responds to and resolves youth grievances . Act as first public contact with agency when...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- City of New York (New York, NY)
- …and administer the contractual grievance process. Serve as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before ... play a key role in managing internal labor relations investigations, union grievances , and collective bargaining agreements and engagement with Union Partners, and… more
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more
- TEKsystems (Honolulu, HI)
- …Conducts critical analysis of highly complex and sensitive member and provider appeals , inquiries and grievances and applies internal policies and procedures, ... position and concerns to management and decision makers. Assists Supervisor and Coordinator in working as a liaison with providers, members and internal decision… more
- State of Colorado (Adams County, CO)
- …+ Ensure that youth grievance policy and procedure are followed. Review of grievances to include investigation, follow up and appropriate action Shift Supervision + ... of the department's action. For more information about the appeals process, the official appeal form, and how to...this position, please direct your inquiries to our ADAAA Coordinator , Nancy Schmelzer, at cdhs_###@state.co.us or call ###. ~THE… more
- State of Colorado (Denver, CO)
- …and disciplinary actions. + Addresses employee complaints and resolves informal grievances . + Positions start the hiring process, interview applicants, and recommend ... by the State Personnel Director. You will find the appeals process, the official appeal form, and how to...this position, please direct your inquiries to our ADAAA Coordinator , Nancy Schmelzer, atcdhs_###@state.co.usor call ###. THE STATE OF… more
- Humana (Springfield, IL)
- …immediate and acute gaps in care and access. + Assists enrollees with filing grievances and appeals . + Provides information to enrollee related to MCO ... for the care and wellbeing of members. The Care Coordinator _(Care Coach 1)_ employs a variety of strategies,...skills to make an impact** **Required Qualifications** The Care Coordinator _(Care Coach 1)_ must meet **one (1)** of… more
- Community Legal Services, Inc. (Philadelphia, PA)
- …researching relevant rules, and applying them to cases + Filing administrative appeals and engaging in administrative advocacy under the supervision of an attorney ... + Representing clients (with attorneys) at administrative hearings or informal grievances with Medicaid Managed Care Organizations as needed + Presenting community… more