- Molina Healthcare (Boise, ID)
- …and evaluate appeal and grievance request to identify and classify member grievances , hand-off to appropriate department for appeals ; regulatory complaints as ... for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member grievances… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- Independent Health (Buffalo, NY)
- …responsible for the collection and review of medical records specific to quality complaints/ grievances and appeals as indicated in support of a high performing ... plan and physician network. The Clinical Reviewer will investigate quality complaints/ grievances and appeals , document research of initial coverage… more
- LA Care Health Plan (Los Angeles, CA)
- …and smooth business operations. Analyzes and resolves complex problems dealing with grievances and appeals . Provide policy and procedure interpretation and ... Behavioral Health Operations Specialist II Job Category: Clinical Department: Behavioral Health...leads regular meetings with vendors, track and analyze metrics, lead solutions and review/audit files, to improve health outcome… more
- Tufts Medicine (Boston, MA)
- …a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee Relations ... 5. Provides union contract administration including the investigation of grievances , drafting grievance responses, MOA preparation. 6. Coordinates and prepares… more
- City of New York (New York, NY)
- …with beneficiaries to answer questions and clarify Medicare Advantage plan specifics. Appeals and Grievances Support: - Assist beneficiaries in understanding ... to join our team as a Health Benefits Information Specialist . In this role, you will be tasked to...to provide invaluable support to Medicare beneficiaries but also lead outreach initiatives to educate and empower our community.… more
- CareOregon (Portland, OR)
- …following areas: Provider relations, managed care operations (eg, claims, appeals , grievances , customer service), medical/behavioral health clinic operations, ... Job Title Provider Relations Specialist , Senior Requisition # 25025 Exemption Status Exempt...administrative processes and regulatory requirements. + Autonomously develop and lead group training sessions and presentations. Provider Relations +… more
- Elevance Health (Overland Park, KS)
- …relevant parties of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from patients, ... creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are… more
- State of Colorado (Sterling, CO)
- …promotes a safe and secure environment. Supervision - provides supervisory or work lead duties for assigned inmate workers; promotes a high level of performance by ... pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and...with other staff members and inspire teamwork + Supervisory/Work Lead Skills - ability to motivate inmates to work… more