- 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 ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides… more
- LA Care Health Plan (Los Angeles, CA)
- …Collaborates with internal departments (Member Services, Provider Network Operations, Claims, Utilization Management , Pharmacy, and Quality Management ) to ... Manager, Customer Solution Center Appeals and Grievances Job Category: Customer...work collaboratively with multiple departments (Claims, Provider Network Operations, Utilization Management , Quality Management , Pharmacy)… more
- Elevance Health (Woodland Hills, CA)
- …+ The analyst may serve as a liaison between grievances & appeals and /or medical management , legal, and/or service operations and other internal ... you for payment as part of consideration for employment. ** Grievances and Appeals Analyst I** + Job...to convey the determination. + Responsibilities exclude conducting any utilization or medical management review activities which… more
- LA Care Health Plan (Los Angeles, CA)
- …Skills Required: Knowledge of state, federal and regulatory requirements in Appeals /Care/Case/ Utilization Management /Quality. Strong verbal and written ... Supervisor, Appeals and Grievances Clinical Operations RN...a lead/supervisory experience. Equivalency: Completion of the LA Care Management Certificate Training Program may substitute for the supervisory/… more
- Molina Healthcare (Long Beach, CA)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical...analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory,… more
- LA Care Health Plan (Los Angeles, CA)
- Clinical Operations Executive Job Category: Management /Executive Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... Officer (CMO) and is responsible for operational and administrative management of the Utilization Management ...Operating Officer (COO) to allow for integration with claims, appeals and grievances , and our customer service… more
- LA Care Health Plan (Los Angeles, CA)
- …departments throughout LAC including but not limited to QI, Pharmacy, Care Management , Utilization Management , Risk Adjustment, Products, Customer Solution ... is responsible for strategizing quality improvement programs and ongoing management using a data-driven focus that sets priorities for...Center (CSC), reporting and Analytics, Appeals and Grievances and the provider network.… more