- Robert Half Accountemps (Long Beach, CA)
- Description We are seeking an experienced Medical Grievances and Appeals Specialist to join our dynamic team. The successful candidate will be responsible ... for managing all grievances, appeals and complaint processes related to medical ...regulations. + Provide educational assistance to members regarding the grievance and appeals process. + Ensure record… more
- Elevance Health (Woburn, MA)
- ** Grievance / Appeals Representative II** **Location:** Hybrid 500 Unicorn Park Drive Woburn, MA The ** Grievance / Appeals Representative II** is responsible ... or outside consultant. + Triages clinical and non-clinical inquiries, grievances and appeals , prepares case files for member grievance committees/hearings. +… 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: ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...This position will focus on quality review of non-clinical grievance and appeals cases for all line… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered...and Pharmacy requests and makes accurate judgment on appeal, grievance , Provider Claim Disputes, medical records or… more
- Molina Healthcare (Milwaukee, WI)
- … appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests and reviews medical records, notes, and/or detailed ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeal and Grievance Compliance Advisor Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances ... exemption, LA Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. LA Care will review all… more
- Indian Health Service (Gallup, NM)
- …Service unit for the Navajo Area Indian Health Service, Duty Station: Gallup Indian Medical Center, Gallup Service Unit in Gallup, New Mexico. The employee serves as ... advice on the preparation of disciplinary and adverse action, and administrative grievance , and evidentiary documents required to execute the actions while complying… more
- The Cigna Group (Bloomfield, CT)
- …of medical services as well as Part B and Part D drug. The Appeals Specialist will be responsible for analyzing and responding appropriately to appeals ... **Cigna Healthcare Medicare Appeals Reviewer:** We will depend on you to...outcome of the appeal; provide oversight and assistance to Medical Management staff with resolution of appeal by interpreting… more
- State of Colorado (Denver, CO)
- …that computer data entry, referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance ... Defined Contribution Plan, plus 401K and 457 plans; + Medical and dental health plans; + Paid life insurance;...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- …Defined Benefit Plan or PERA Defined Contribution Plan plus 401K and 457 plans; + Medical and dental health plans; + Short and long term disability coverage; + Paid ... and admission data summary that includes criminal history, social history, medical , dental, mental health needs, occupational experience and interests, vocational… more
- State of Colorado (Denver, CO)
- …all committed youth at each youth center are assigned a Behavioral Health Specialist who provides individual therapy each week. They also attend at least three ... team meetings in collaboration with CYSO III + Ensure that youth grievance policy and procedure are followed. Review of grievances to include investigation,… more
- City of Lakeland (Lakeland, FL)
- …claims processing and represents the City of Lakeland in unemployment claims and appeals hearings, securing the participation of the HR Director and HR counsel for ... with ADA and accommodations in partnership with the Labor and Employee Relations Specialist . + Works with departments to assess needs and provide solutions in… more