- CVS Health (Hartford, CT)
- …experience Preferred Qualifications + Utilization Review experience + Medicare experience + Appeals experience Education + Associate 's Degree or RN diploma ... with occasional rotational weekend and holiday coverage. Position Summary The Appeals Nurse Consultant position is responsible for processing the medical necessity… more
- Apex Health Solutions (Houston, TX)
- …is focused on the processing of customer and provider Medicare and Commercial appeals and grievances. This associate may screen incoming complaints, process ... Job Title: Appeals & Grievances Coordinator Department: Appeals and Grievances Supervisor: Manager, Appeals & Grievances FLSA Status: Nonexempt Summary The … more
- Equal Employment Opportunity Commission (Washington, DC)
- …Director of Appellate Review Programs (ARP) manages the EEOC's national federal sector appeals program. The Associate Director position is designated as SES, ... and long-range planning and policy development for the agency's administrative appeals program; determines program priorities; and revises and ensures the legal… more
- Universal Health Services (Reno, NV)
- …Job Summary: Under the direction of the Manager of Operations, the Appeals Specialist is responsible for ensuring the appropriate review, research, processing and ... responding to written member and provider complaints, appeals , and grievances. This position is required to apply analytical and critical thinking when reviewing… more
- Magellan Health Services (Boise, ID)
- Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests. In some cases may be ... medical necessity reviews. + Enters all data related to appeals and case reviews into a database. + Prepares...Education - Required GED, High School Education - Preferred Associate License and Certifications - Required License and Certifications… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- CVS Health (Hartford, CT)
- …residence. Position OverviewAdministers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical records to apply appropriate ... class policies, plans, and procedures in support of the Appeals area objectives. + Executes review of all clinical...+ Exceptional verbal and written communication skills Education + Associate 's Degree or RN diploma required Pay Range The… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- Centralized Appeals Unit - Coordinator 1 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4385665) Centralized Appeals Unit - Coordinator ... + Description + Benefits Minimum Qualifications Please clickHERE (https://ulsuno.wd1.myworkdayjobs.com/en-US/UniversityOfNewOrleans/job/Baton-Rouge-La/Centralized- Appeals -Unit Coordinator-1-3\_R-001261?q=r-001261) to apply. + Review, analyze, and… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Appeals Paralegal** **Job Class: Paralegal** **Agency: Human Services Dept** + **Who May Apply** : Open to all qualified job seekers + **Date ... AFSCME + **Division/Unit** : DHS - Central Office / Appeals Paralegal Supv + **Work Shift** : Day Shift...an accredited program which resulted in a program certificate, associate degree, bachelor's degree or post bachelor's degree; OR… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting… more
- Centene Corporation (Phoenix, AZ)
- …and scanning incoming mail **Education/Experience:** High school diploma or equivalent. Associate 's degree preferred. 2+ years grievance or appeals , claims ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Grievance and Appeals Coordinator 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #660 Monday, April 1, 2024 Centers Plan for Healthy Living's goal is to create ... healthy living. JOB SUMMARY: As an integral part of the Grievance and Appeals (G&A) Department, the G&A Coordinator lends their support in processing member-related… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management/ Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct… more
- Trinity Health (Farmington Hills, MI)
- …as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned PBS location. Reviews, researches and resolves ... knowledge of state/federal laws as they relate to contracts and the appeals process. Investigates and addresses overpayment and underpayment accounts with the… more
- State of Indiana (Indianapolis, IN)
- Appeals Operations Director Date Posted: Apr 25, 2024...Degree and 7+ years of experience, or + an Associate 's Degree and 9+ years of experience, or + ... at least 11+ years of experience applying the below, outlined knowledge, skills, and abilities in a similar role. You must meet the following requirements to be considered for employment: + Mastery knowledge in program subject matter obtained through… more
- SUNY Geneseo (Geneseo, NY)
- Associate Provost for Academic Success Bookmark this Posting | Print Preview | Apply for this Job Please see Special Instructions for more details. Applicants should ... date is late June 2024. Vacancy Announcement Position Information Campus Title Associate Provost for Academic Success Department Office of the Provost Position… more
- Boston College (Chestnut Hill, MA)
- …Reporting to the Director of Annual Giving Direct Marketing, the Assistant/ Associate Director is responsible for the coordination and execution of Boston ... with Advancement Information Services and Communications and Marketing. The Assistant/ Associate Director is a vital contributor to the successful implementation… more
- Boston University (Boston, MA)
- …projects and communications, Master's and professional student resources, and the graduate student appeals process in the Office of the Provost. The Director will be ... The director may coordinate a re-envisioned Graduate Student Advisory Board. 4. Student Appeals (10%): The Director will oversee the student appeals process in… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- Associate Director of Leadership Giving and Stewardship Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4422747) Apply Associate Director ... Information Baton Rouge Community College (BRCC) seeks to fill the position of Associate Director of Leadership Giving and Stewardship. The Associate Director of… more