- Centene Corporation (Sacramento, CA)
- …Woodland Hills or Natomas offices **Position Purpose:** Ensure appropriate processing of member grievance appeals , provider appeals , or request for a State ... of contact with the State. Manage the day to day responsibilities of the Grievance & Appeals Coordinators. + Ensure that the Grievance and Appeals … more
- TEKsystems (Long Beach, CA)
- …reside in CA, AZ, TX, NM, or NV JOB PURPOSE: Facilitates the member grievance and appeal process by investigating, documenting and preparing case files to meet all ... regulatory requirements. ESSENTIAL JOB RESULTS: Investigates member grievance and appeal by gathering supporting documentation from internal departments, contracted… 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: Los ... net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General...and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best… more
- LA Care Health Plan (Los Angeles, CA)
- …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and cohesive unit with...the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB… more
- CenterWell (Sacramento, CA)
- …call center or related customer service experience + 1 - 3 years of grievance and appeals experience + Previous experience processing medical claims + Bilingual ... and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by...review of clinical documentation to determine if an a grievance , appeal or further request is warranted and then… more
- LA Care Health Plan (Los Angeles, CA)
- …all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters ... collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory… more
- Sharp HealthCare (San Diego, CA)
- …Chief Medical Officer and reports findings in conjunction with the Quality Improvement Manager . + Participates in the grievance process with the Chief Medical ... policy as needed. + Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager to identify trends… more
- Sharp HealthCare (San Diego, CA)
- …to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager to identify ... needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its'...data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources. + Achieves and maintains… more
- Elevance Health (Costa Mesa, CA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... 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