- Banner Health (AZ)
- … care and accessibility concerns and inquiries on the various levels of the grievance and appeals process. CORE FUNCTIONS 1. Determines which claim disputes meet ... Pay Transparency Rules. Great careers are built at Banner Health . We're looking for the best and brightest to... grievance and appeal issues. 7. Reports at Grievance / Appeals meetings, as appropriate, all incoming, attended… more
- CVS Health (CT)
- …**Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly Preferred ... At CVS Health , we're building a world of health ...of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C 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
- Actalent (Dallas, TX)
- …Diploma or equivalent + Experience: Minimum 2 years in managed care (call center, appeals , or claims) + Experience in health claims processing, coordination of ... Job Title: Specialist, Appeals & GrievancesJob Summary: Responsible for reviewing and...to change and may be subject to specific elections, plan , or program terms. If eligible, the benefits available… more
- BayCare Health System (Clearwater, FL)
- …be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist- Health Plan **Location** Clearwater:Park Place ... + Triage, plan , and execute intake of Appeals and Grievance submissions. + Keeping track...deep understanding of gap closure specifications. + Knowledge of health plan operations, benefit coverage, and claims… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …+ Preferred experience in a Third-Party Administrator (TPA) setting About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement ... including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals , Utilization Review, and Grievance processes including...self to work with all your unique abilities. Brighton Health Plan Solutions partners with self-insured employers,… more
- LA Care Health Plan (Los Angeles, CA)
- …6 years of clinical acute care experience with at least 3 years of experience with health care grievance and/or appeals issues, preferably in a managed care ... be willing to relocate Established in 1997, LA Care Health Plan is an independent public agency...and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best… more
- Sanford Health (Sioux Falls, SD)
- …related field required. Master's degree preferred. Minimum of 7 years of experience in health plan appeals and grievances, regulatory oversight, or health ... a drug screen and pre-employment background screening as a condition of employment. **Req Number:** R-0237044 **Job Function:** Health Plan **Featured:** No more
- AmeriHealth Caritas (Philadelphia, PA)
- …of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial ... management + Monitors to ensure that all problems with appeals /grievances presented by plan members/participants are resolved...Care environment + 1 to 3 years' experience in grievance / appeals environment required **The Ideal Person will… more
- LA Care Health Plan (Los Angeles, CA)
- …$77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by the state of ... to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan . Serving more than 2 million members, we make sure our… more
- LA Care Health Plan (Los Angeles, CA)
- …$67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by the state of ... County residents. We are the nation's largest publicly operated health plan . Serving more than 2 million...This position will focus on quality review of non-clinical grievance and appeals cases for all line… more
- Elevance Health (Atlanta, GA)
- **Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... unless an accommodation is granted as required by law._ The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- CenterWell (Helena, MT)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... customer service experience + 1 - 3 years of grievance and appeals experience + Previous experience...provides medical, dental and vision benefits, 401(k) retirement savings plan , time off (including paid time off, company and… more
- Humana (Louisville, KY)
- **Become a part of our caring community and help us put health first** The Appeals Representative 4 Investigates and resolves member and practitioner issues. ... review of clinical documentation to determine if an a grievance , appeal or further request is warranted. Job Description...appeal or further request is warranted. Job Description The Appeals Representative 4 + Review documents + Building cases… more
- LA Care Health Plan (Los Angeles, CA)
- …Range: $47,840.00 (Min.) - $57,062.00 (Mid.) - $68,474.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by the state of ... County residents. We are the nation's largest publicly operated health plan . Serving more than 2 million...file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances… more
- Sharp HealthCare (San Diego, CA)
- **Facility:** Health Plan **City** San Diego **Department** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California ... the Chief Medical Officer, oversees medical care for Sharp Health Plan (SHP) products and services and...data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources. + Achieves and maintains… more
- Sharp HealthCare (San Diego, CA)
- **Facility:** Health Plan **City** San Diego **Department** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Doctor of ... Senior Medical Director position provides critical management and oversight for Sharp Health Plan 's (SHP) physicians (Medical Directors (both medical and… more
- Fallon Health (Worcester, MA)
- …or follow us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Fallon Health Appeals and Grievance process is an essential function to ... requirements and/or changes, and team case review outcomes. + Administrate Fallon Health Standard and Expedited Appeals Processes as outlined in Member… more
- LA Care Health Plan (Los Angeles, CA)
- …$77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by the state of ... County residents. We are the nation's largest publicly operated health plan . Serving more than 2 million...CSC staff on identified areas of improvement, such as Appeals and Grievance processes, Claims, etc. Through… more
- Molina Healthcare (GA)
- **Job Description** **Job Summary** Molina Health Plan Operations jobs are responsible for the development and administration of our State Health Plan 's ... and local regulations. **Knowledge/Skills/Abilities** * Under the leadership of the VP, Health Plan Operations, plans, organizes, staffs, and coordinates the… more