- Evolent (Montgomery, AL)
- …is required. + Minimum of 5 years in Utilization Management, health care Appeals , compliance and/or grievances /complaints in a quality improvement environment is ... for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of… more
- VNS Health (Manhattan, NY)
- …Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances . + Ensures the accuracy and integrity of data ... of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals (RN)to lead the...Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long… more
- Fallon Health (Worcester, MA)
- …other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH ... standards. The Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals &… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances...clerical/administrative responsibilities at the discretion of the Director or Manager . * Providing administrative assistance in support of the… more
- Elevance Health (Tampa, FL)
- …Department responsible to review, analyze and process pre service and post service grievances and appeals requests related to clinical and non clinical services, ... and analysis of complex pre service and post service grievances and appeals requests from customer and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CareFirst (Baltimore, MD)
- …educational and training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in the development and ... data related to the volume and complexity of the appeals and grievances submitted for resolution. **QUALIFICATIONS:**...Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred + LNCC - Legal Nurse… more
- University of Delaware (Newark, DE)
- Manager , Employee & Labor Relations Job no: 501883 College / VP Area:Office of Human Resources Work type: Staff Location: Newark/Hybrid Categories: Human Resources, ... Director, Employee and Labor Relations, the Employee and Labor Relations Manager , is responsible for managing day-to-day employee and labor relations functions.… more
- HCA Healthcare (Rochester, NH)
- …nurses set us apart from any other healthcare provider. We are seeking aCase Manager to join our healthcare family. **Currently offering sign on bonus up to $10k** ... - and empowers their passion for patient care. Apply today for our Case Manager opportunity. **Job Summary and Qualifications** The Case Manager is responsible… more
- Beth Israel Lahey Health (Burlington, MA)
- … grievances involving colleagues; interview and select, with the manager , candidates for employment.** **Proactively develop plans to meet future ... discusses issues with outside auditors and the inpatient coding manager /CDI. Prepares appeals on appropriate cases to...within the confines of said policies and . handle grievances appropriately.** **Listen to and respond to employee problems… more
- State of Colorado (Chaffee County, CO)
- CDOC Corrections Case Manager I (Buena Vista) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4921223) Apply CDOC Corrections Case Manager ... Supervision, Individualized Program Instruction/Tutoring, Multi-Disciplinary Staffing, Responding to Offender Grievances and Resolving Offender Issues, Offender Housing Placement 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 ... **Overview** **Claims Manager ** **Servicing** **Health Insurance Policies or Benefits** **Summary:**...stated coverage. Join Premier Administrative Solutions as a Claims Manager and lead our Claims Department in delivering exceptional… more
- Skookum Contract Services (Bremerton, WA)
- …same. + Investigate, prepare documentation, and recommend Tessera's position on grievances , complaints, and appeals . Responds to employee relation issues ... with union officials and adheres to terms of labor contract by supporting Manager in the day-to-day implementation of policies concerning wages, hours, and working… more
- Ventura County (Ventura, CA)
- …agencies as needed; + Serves as the compliance point of contact for grievances , appeals , and Notices of Adverse Benefit Determinations (NOABDs); + Supervises ... Behavioral Health Compliance Manager Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4774428) Apply Behavioral Health Compliance Manager … 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 ... to Dental Support Organization (DSO) partners. As a **Key DSO Dental Account Manager , Dental Support Organizations** , you will be responsible for growing the… more
- Elevance Health (Bloomington, IN)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + BA/BS degree ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- State of Colorado (Denver, CO)
- …and guidance on issues that relate to performance management, progressive discipline, employee grievances and appeals , and civil rights. You will also be the ... be invited to schedule an interview with the hiring manager . Transfer, Non-Disciplinary Demotion or Reinstatement If you believe...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Dairy Farmers of America (Lubbock, TX)
- …including but not limited to recruiting, hiring, training, performance management, counseling, grievances , and appeals + Maintain advanced knowledge of brakes, ... electrical systems, suspensions, and structural components of tank trailers and the direct repair and maintenance of + The requirements herein are intended to describe the general nature and level of work performed by employee, but is not a complete list of… more
- New York State Civil Service (Albany, NY)
- …issues.* Assisting in providing advice and consultation to supervisors, manager , directors, and Executives ensuring proper interpretation and administration of ... contract provisions relating to employee grievances or issues.* Assisting in the administration of the...issues involved, preparing EHS-707 and supporting referral data; managing appeals process for Section 72 appeals , including… more
- State of Colorado (Denver, CO)
- …the Quality and Standards Division within BHA and reports directly to the Grievances and Enforcement Manager . The Quality and Standards Division oversees the ... on behalf of the BHA and receives and investigates grievances submitted to the BHA through complaints and critical...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Sharecare (Augusta, ME)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances / appeals , utilization management (UM) status, including but not limited to ... payers or 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management...Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide +… more
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