- CenterWell (Washington, DC)
- **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
- Evolent (Washington, DC)
- …or GED is required. + Minimum of 3 years' experience in an Appeals and Grievances role or comparable administrative role within a health plan, managed ... Stay for the culture. **What You'll Be Doing:** The **Coordinator, Appeals and Grievances ** at Evolent is responsible for reviewing and processing case requests,… more
- Evolent (Washington, DC)
- …**Required** + Minimum of 5 years in Utilization Management, health care Appeals , compliance and/or grievances /complaints in a quality improvement environment- ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...to 7pm CST (which includes 30-minute unpaid lunch break) 3 days/week, to meet the business needs of nurses… more
- Cognizant (Washington, DC)
- …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
- Somatus (Mclean, VA)
- …the Regulatory and Accreditation Team to ensure compliance with audits, complaints/ grievances , and adherence to contractual obligations and Service Level Agreements ... client pre-delegation audits, annual client audits, development of grievance and appeals workflow processes, and other regulatory requirements. + Direct, implement,… more
- Justice, Bureau of Prisons/Federal Prison System (Washington, DC)
- …Some examples of this qualifying experience are: GS-13: Experience investigating grievances submitted as administrative remedy appeals , regarding Women and ... of the total possible points for the vacancy KSAs or competencies; and 3 . Submit the appropriate documentation to support your CTAP eligibility. NOTE: Applicants… more