- Jobleads-US (Portland, OR)
- …employee complaints, policy violations, disciplinary actions, and employee and applicant appeals and grievances . Provides guidance and recommendations for ... bargaining agreement. The position supervises the Corporate Human Resource Manager , Benefits Administrator, and the Learning and Development Department. Reports… more
- Molina Healthcare (AZ)
- …knowledge although they may have technical team members. **Expanded Scope:** The Senior Project Manager for Claims Operations drives complex, multi-workstream ... Design scalable workflows and controls across intake, adjudication, adjustments, appeals / grievances , and payment integrity. + Technology Enablement: Oversee… more
- CVS Health (Springfield, IL)
- …Integrated Product Experience + Experience with Part D Coverage Determination, Appeals and Grievances and/or Formulary Administration regulatory requirements and ... audit management + Experience with Part C & D reporting requirements + 3+ years serving as project lead + Adept at problem solving and decision making + Experience dealing with state or federal regulators + Excellent written and verbal communication skills and… more
- Sharp HealthCare (San Diego, CA)
- …as needed.Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify trends in ... and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight...needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its'… 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:**...as transparency in reporting results, trends and issues to Senior Management and clients. * Management of relationships with… more
- LA Care Health Plan (Los Angeles, CA)
- …purpose. Job Summary The Technical Application Manager II reports to the Senior Manager Information Technology IT Solutions Delivery. This role acts as the ... Technical Applications Manager II Job Category: Information Technology Department: IT...of Membership Eligibility and Enrollment, Member Maintenance, PCP assignment, Appeals and Grievances preferred. EDI 5 years… more
- Sharp HealthCare (San Diego, CA)
- …+ Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify trends in ... care needs of the membership. Serves as a medical manager and policy advisor to SHP and its Chief...the ability to interface effectively with employees, members, physicians, senior management, and the public at large. + Management… more
- Volunteers of America Los Angeles (Los Angeles, CA)
- …, and complaints, refers complex matters to HR Employee Relations Specialist or Senior Manager of Employee Relations as required + Participates in training ... generalist work with 30%dedicated time committed to handling employee complaints, grievances , interactive processes, and disciplinary actions. + Experience with case… more
- State of Colorado (Lakewood, CO)
- …functions. Regulatory Administration, Management and Oversight + Serves as manager for the Enforcement, Investigations, Licensing, and Veterinarian sections. + ... personnel actions. + Resolve problems, performance issues, disputes, and informal grievances and initiate corrective action or recommend discipline as needed. +… more
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