- 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
- Evolent (Sacramento, CA)
- …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
- 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
- Evolent (Sacramento, CA)
- …**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 (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
- Molina Healthcare (Sacramento, 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
- 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