- CenterWell (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: ... required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations...years of clinical acute care experience with at least 3 years of experience with health care grievance and/or… more
- LA Care Health Plan (Los Angeles, CA)
- …Degree Experience Required: At least 3 years in a healthcare setting in Grievances and Appeals , Compliance, Claims or Call Center. At least 2 years of ... Supervisor, Customer Solution Center Appeals and Grievances (Temporary) Job Category: Management/Executive Department: CSC Appeals & Grievances Location:… more
- Centene Corporation (Sacramento, CA)
- …field or equivalent experience. 3 + plus years of experience in healthcare/law, grievances and appeals . Previous experience as a lead in a functional area, ... Ensure that the Grievance and Appeals department processes all appeals and grievances in accordance with referred time frames and other contractual legal… more
- Cognizant (Sacramento, CA)
- …or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews . ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… 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
- Molina Healthcare (San Bernardino, CA)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
- LA Care Health Plan (Los Angeles, CA)
- …Training Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... CSC staff on identified areas of improvement, such as Appeals and Grievance processes, Claims, etc. Through various delivery...may be considered. Education Preferred Experience Required: At least 3 years of previous experience as a trainer in… more
- City and County of San Francisco (San Francisco, CA)
- …bargaining agreements. + Key duties include negotiating resolutions to grievances , investigating complaints of serious employee misconduct, and conferring with ... degree from an accredited college or university. Experience: Three ( 3 ) years of verifiable professional human resources experience, similar...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- LA Care Health Plan (Los Angeles, CA)
- …Functional knowledge of Membership Eligibility and Enrollment, Member Maintenance, PCP assignment, Appeals and Grievances preferred. EDI 5 years of EDI Domain ... Portal etc.) from each Domain System * Provide Level 3 Production Support for each Domain System * Drive...IT Vendor (Software and Consultant) Management. Preferred: At least 3 years of Production Support experience. At least … more
- Sacramento County (Sacramento, CA)
- …are at 5:00 pm on: 9/26/2025, 10/24/2025, 11/26/25, 12/26/25, 1/23/26, 2/27/26, 3 /27/26, 4/24/26, 5/22/26, 6/26/26 Nurse Practitioners provide a range of health care ... Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days...Pay a fair share fee to the union; or, 3 . Meet specific requirements under which an equivalent amount… more