- Regal Medical Group, Inc. (West Covina, CA)
- …in concert with other staff to problem-solve member issues and give feedback on Appeals and Grievance activities. Ability to make sound decisions and present and ... as an intra-team contact for staff for questions on appeals and grievances and offers assistance as may be...QI P & P are followed. QI Team Nurse Specialist is a key member of the QI Department… more
- PHI Health (Phoenix, AZ)
- …timely payments. This includes escalation of issue to supervisors and/or grievance departments. Categorize and quantify payer payment issues for resolution and ... policies and procedures. Draft correspondence to patients and payers including 1st level appeals for technical denials, and identify accounts to refer to Appeals … more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... **Supervision Exercised:** No **Essential Duties & Responsibilities** Processing of Grievances & Appeals : + Responsible for the progress of grievance and appeal… more
- Robert Half Accountemps (Los Angeles, CA)
- Description A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist . The Grievance & Appeals Specialist , ... and resolving denied claims, complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform… more
- LA Care Health Plan (Los Angeles, CA)
- …in a consistent and accurate manner. This position will focus on quality review of non- clinical grievance and appeals cases for all line of business (LOB) ... Customer Solution Center Appeals and Grievances Quality Auditing Specialist ...executing, tracking, and assessing targeted and random audits for non- clinical grievance and appeal case documentation. Ensure… more
- LA Care Health Plan (Los Angeles, CA)
- …providers. Duties Provide non- clinical support to the Customer Solution Center Appeals and Grievance Specialists for L. A. Care's Medicare Advantage program. ... responses. (25%) Under the supervision of the Appeals and Grievance Manager, assist with soliciting non- clinical information from Participating Physical… more
- Tufts Medicine (Boston, MA)
- …involving a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee ... union contract administration including the investigation of grievances, drafting grievance responses, MOA preparation. 6. Coordinates and prepares information for… more
- State of Colorado (CO)
- …Job Number CAA Physician 06/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 06/05/2025 Closing Date 10/31/2025 ... on-call assessment, diagnosis, and treatment of inmates in one or more prison clinical settings. Physicians are responsible for, but not limited to, the following: +… more
- Elevance Health (Los Angeles, CA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... ** Clinical Operations Associate Medical Director** **Carelon MBM -...health profession. **Preferred skills, capabilities, and experiences:** + Oncology specialist preferred + Internal medicine specialist preferred… more
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