- Molina Healthcare (Boise, ID)
- …and evaluate appeal and grievance request to identify and classify member grievances , hand-off to appropriate department for appeals ; regulatory complaints as ... for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member grievances… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is...membership. This position is responsible for monitoring Appeal and Grievances Specialists, Lead Intake, and Senior Appeal… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- Independent Health (Buffalo, NY)
- …responsible for the collection and review of medical records specific to quality complaints/ grievances and appeals as indicated in support of a high performing ... plan and physician network. The Clinical Reviewer will investigate quality complaints/ grievances and appeals , document research of initial coverage… more
- LA Care Health Plan (Los Angeles, CA)
- …and smooth business operations. Analyzes and resolves complex problems dealing with grievances and appeals . Provide policy and procedure interpretation and ... Behavioral Health Operations Specialist II Job Category: Clinical Department: Behavioral Health...leads regular meetings with vendors, track and analyze metrics, lead solutions and review/audit files, to improve health outcome… more
- Tufts Medicine (Boston, MA)
- …a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee Relations ... 5. Provides union contract administration including the investigation of grievances , drafting grievance responses, MOA preparation. 6. Coordinates and prepares… more
- City of New York (New York, NY)
- …with beneficiaries to answer questions and clarify Medicare Advantage plan specifics. Appeals and Grievances Support: - Assist beneficiaries in understanding ... to join our team as a Health Benefits Information Specialist . In this role, you will be tasked to...to provide invaluable support to Medicare beneficiaries but also lead outreach initiatives to educate and empower our community.… more
- CareOregon (Portland, OR)
- …following areas: Provider relations, managed care operations (eg, claims, appeals , grievances , customer service), medical/behavioral health clinic operations, ... Job Title Provider Relations Specialist , Senior Requisition # 25025 Exemption Status Exempt...administrative processes and regulatory requirements. + Autonomously develop and lead group training sessions and presentations. Provider Relations +… more
- Elevance Health (Overland Park, KS)
- …relevant parties of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from patients, ... creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are… more
- State of Colorado (Sterling, CO)
- …promotes a safe and secure environment. Supervision - provides supervisory or work lead duties for assigned inmate workers; promotes a high level of performance by ... pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and...with other staff members and inspire teamwork + Supervisory/Work Lead Skills - ability to motivate inmates to work… more