- CenterWell (Raleigh, NC)
- **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
- Humana (San Juan, PR)
- **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
- Sanford Health (Sioux Falls, SD)
- … appeals and grievances , regulatory oversight, or health policy. At least 3 years in a leadership role managing appeals , grievances , or regulatory ... appeals and grievance resolution. Lead and manage the end-to-end appeals and grievances process for all product lines, ensuring compliance with federal and… 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
- AmeriHealth Caritas (Newark, DE)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the ... management + Monitors to ensure that all problems with appeals / grievances presented by plan members/participants are resolved...experience in a Managed Care environment + 1 to 3 years' experience in grievance/ appeals environment required… more
- Elevance Health (Columbus, OH)
- …an accommodation is granted as required by law._ The **Manager II Grievance & Appeals ** responsible for management oversight of grievances and appeals ... departmental units to investigate, resolve, and respond to grievances and appeals , manages inventory and production...degree and a minimum of 5+ years grievance & appeals experience and a minimum of 3 … more
- Elevance Health (Norfolk, VA)
- …HS diploma or GED and a minimum of 3 years experience working in grievances and appeals , claims, or customer service; or any combination of education and ... reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, regulatory and… more
- Area Agency On Aging 1-b (Southfield, MI)
- …Appeals and Grievance Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual, regulatory, and ... and Grievance Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual,...to Advanced. OUR INDUSTRY-LEADING BENEFITS CONSISTS OF: Choice of 3 excellent next to zero cost Medical Plans including… more
- Elevance Health (Atlanta, GA)
- …not eligible for employment based sponsorship. **Responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and ... respond to grievances and appeals , manages inventory and production...degree and a minimum of 5+ years grievance & appeals experience and a minimum of 3 … more
- BayCare Health System (Clearwater, FL)
- …provide updates to management. + Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future ... respect, responsibility and clinical excellence. **Summary:** + Manages intricate grievances , collaborating closely with healthcare providers and members to resolve… more
- State of Colorado (Sterling, CO)
- …plans, and conducts performance evaluations; resolves informal staff and/or inmate grievances . Assigns tasks, monitors and inspects work progress and ensures ... pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and...of work experience as follows: A minimum of three ( 3 ) years of employment experience as described above may… more
- CUNY (Brooklyn, NY)
- …Rules); tracking student conduct reports; coordinating the student conduct process, grievances , and appeals . + Oversee the Faculty Student Disciplinary ... process, early intervention student support service process, the resolution of student grievances , appeals , and complaints, and the utilization of the Behavioral… more
- Space and Naval Warfare Systems Command (Loma, ND)
- …on the technical aspects of personnel administration during formal hearings, grievances and appeals . Requirements Conditions of Employment Qualifications NO-04: ... advice and assistance in the areas of discipline, adverse actions, grievances , employee counseling, and related functions including appropriate options for proper… more
- State of Colorado (Denver, CO)
- …professional development training (as available). Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, ... interventions for all youth. Responds to and resolves youth grievances . Act as first public contact with agency when...should not disqualify the applicant from the current position, ( 3 ) provide the employee number from the applicant's prior… more
- City of New York (New York, NY)
- …United States law school as defined in the Rules of the New York Court of Appeals (Sections 520. 3 or 520.5) or admission to the New York State Bar. Additional ... related to labor law and employee discipline. The unit handles employee grievances , prosecutes disciplinary cases, and works with attorneys at the Mayor's Office… more
- Navy Exchange Services (NEX) (Jacksonville, FL)
- …discipline. Provides guidance and assistance to management on disciplinary actions, grievances , and appeals . Ensures appropriateness of charges and penalties. ... of 8 years consisting of the following: GENERAL EXPERIENCE: 3 years of responsible experience in non-routine work which...a maximum of a 4 year bachelor's degree for 3 years of general experience. AND SPECIALIZED EXPERIENCE: 5… more
- CVS Health (Springfield, IL)
- …issue provider CAP + Monitor Grievances according NCQA standards categories ( 3 grievances per QTR), including progressive corrective action. + Monitor ... Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards * Excellent analytical… 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
- City of New York (New York, NY)
- …issues including license and access issues, leasing, and eminent domain 3 ) procurement related issues including responsive and responsibility issues, bid protests, ... the Uniform Commercial Code ("UCC"); 10) assist division staff with procurement appeals and decision process, including draft opinions and presenting facts and… more