- LA Care Health Plan (Los Angeles, CA)
- Manager , Appeals and Grievances General... & Grievances Department to ensure clinical grievances , complaints , appeals and complex issues ... net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G)...tracks, and resolves internal and external appeal and grievance complaints for LA Care Plan Partners, including identifying opportunities… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... Job Summary The Manager , Customer Solution Center Appeals and Grievances is responsible for the...procedures. This position ensures the proper handling of member complaints whether presented by members, their authorized representative, the… more
- Apex Health Solutions (Houston, TX)
- Job Title: Appeals & Grievances Coordinator Department: Appeals and Grievances Supervisor: Manager , Appeals & Grievances FLSA Status: ... Nonexempt Summary The Appeals and Grievances coordinator position is focused on the processing of...and provider Medicare and Commercial appeals and grievances . This associate may screen incoming complaints ,… more
- Universal Health Services (Reno, NV)
- …the appropriate review, research, processing and responding to written member and provider complaints , appeals , and grievances . This position is required to ... Learn more at: https://prominence-health.com/ Job Summary: Under the direction of the Manager of Operations, the Appeals Specialist is responsible for ensuring… more
- Randstad US (Rancho Cucamonga, CA)
- …years of healthcare customer service experience, specifically handling grievances , appeals , and escalations. The Case Manager will communicate heavily with ... as quickly as possible. + Research, resolve and communicate complaints and grievances filed by members and...Problem Solving + Written Communication + Microsoft Office + Grievances and Appeals + Escalations + Conflict… more
- State of Colorado (Sterling, CO)
- …daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints / grievances at the informal level, responsibility for ... daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints / grievances at the informal level, responsibility for… more
- Pacific Medical Centers (Seattle, WA)
- …for all post service, network and benefit appeals . Acts as second level manager for grievances . Works with patients and or vendor to reach resolution. Refers ... customer feedback on performance of assigned departments; resolves customer complaints , refers unresolved complaints onto the Executive...network and benefit appeals . Acts as second-level manager for grievances . Works with patients or… more
- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- …knowledge of Federal personnel administration areas and processes such as appeals and grievances , management-employee relations, and recruitment and selection ... Summary The Equal Employment Manager provides technical and overall administrative management of...of EEO, Affirmative Action, and strategies for resolving EEO complaints . -Maintains a diversity management program and conducts analysis… more
- Gwinnett County Public Schools (Suwanee, GA)
- …of Employee Relations will assist in providing resolution in matters related to grievances and appeals , training and development to administrators and employees ... ability to investigate effectively and document EEO-related violations and complaints , prepare recommendations to resolve problems, and work with...on equity, compliance, accommodation, grievances , and Title IX.1. Leads equal opportunity and other… more
- Actalent (Franklin, WI)
- …to assist in establishing and maintain community links. Assists members with filing complaints , grievances or appeals and obtaining advocacy services as ... assigned caseload of program members in collaboration with an RN Care Manager + Completes comprehensive member assessments, member centered care plans, & functional… more
- Actalent (Milwaukee, WI)
- …to assist in establishing and maintain community links. Assists members with filing complaints , grievances or appeals and obtaining advocacy services as ... assigned caseload of program members in collaboration with an RN Care Manager * Completes comprehensive member assessments, member centered care plans, & functional… more
- Actalent (Milwaukee, WI)
- …to assist in establishing and maintain community links. Assists members with filing complaints , grievances or appeals and obtaining advocacy services as ... needed. + Maintains member contact standards and documentation standards, and stays informed of current trends and best practices Skills: case management, Medicare, Medicaid, managed care, Badgercare, healthcare industry, healthcare management system, social… more
- Carnival Cruise Line (Miami, FL)
- … grievances raised. + Uses past knowledge and experience to review grievances , complaints , and concerns received via various communication channels including ... related issues, policy, and procedure. + Works autonomously using experience to review appeals from team members to return from a breach of contract (termination or… more
- State of Colorado (Pueblo, CO)
- …guidelines. The Patient Rights and Advocacy Specialist helps patients and families with complaints and grievances . It works closely with the Patient Rights and ... Advocacy Manager to facilitate communication between patients and the hospital...improve the response + Receive written or verbal patient complaints assigned to them by the Work Lead or… more
- State of Colorado (Denver, CO)
- …and labor relations (dispute resolution, performance management, discrimination complaints , and labor agreements); organizational and professional development ... Position performs employee and labor relations to resolve formal grievances , progressive discipline, performance management disputes, labor relations issues under… more
- State of Colorado (Canon City, CO)
- …daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints / grievances at the informal level, responsibility for ... establish an eligible list for referral to the hiring manager for final consideration. Be sure the "Work Experience"...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Federal Transit Administration (Washington, DC)
- …informal complaints of employees and refers others, such as formal grievances and appeals to appropriate authorities. Develops timely performance plans for ... of telework days approved will be determined by your immediate supervisor or manager following the agency's telework policy and guidance. If participating in the… more
- Marshfield Clinic (Marshfield, WI)
- …within established turnaround times. + Assist in the resolution of disputes, grievances , and complaints involving pharmacy program issues. + Perform peer-to-peer ... Interpret clinical guideline criteria to make clinical prior authorization and appeals determinations in accordance with medical necessity and covered benefit… more
- Commonwealth Care Alliance (Boston, MA)
- …or more core operational functions, including call centers, enrollment functions, and appeals / grievances . Knowledge, Skills & Abilities Required: + Knowledge of ... Service, Director of Provider Service, Senior Director of Member Communications, Manager of Training and Quality, Director of Business Strategy and Technology,… more
- Transdev (Hyattsville, MD)
- …policy. + May be called upon to testify on behalf of the company at union grievances or safety appeals meetings. + Ensures all required reports are submitted in ... review site conditions for safety hazards. + Investigate customer complaints related to operator performance and safety. + Conducts...as necessary or requested by the assistant or contract manager . + Maintains an orderly work area. The work… more