- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance ... of the Appeals and Grievances department through many NCQA... department through many NCQA and other related quality program activities including: monthly case quality monitoring, coordination of… more
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …to include the following areas: Medicare Parts A,B, C, & D claim appeals and grievances . Responsibilities Provide Medicare claims appeals operational ... Centers for Medicare & Medicaid Services (CMS), Center for Medicare, Division of Appeals Operations (DAO), Medicare Enrollment & Appeals Group (MEAG). As a… more
- Sharp HealthCare (San Diego, CA)
- …policy as needed. + Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify trends ... the membership. Serves as a medical manager and policy advisor to SHP and its Chief Medical Officer. Is...plan Chief Medical Officer) in short and long range program planning, total quality management (quality improvement), and external… 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 ... of care foundation for our NCQA required population health management program . Additionally, this position provides the representation of physician's insight,… more
- State of Montana (Butte, MT)
- …and advises about new laws that have no case precedent * Serves as a legal advisor across multiple fields of law; may develop expertise in specific fields of law and ... assignment requirements * Ensures appropriate and timeliness of pleadings, motions, appeals , case preparation, scheduling, and follow-up by Public Defenders *… more