- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for...responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances … more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage process for… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... Grievances Location: Los Angeles, CA, US, 90017 Position Type:...purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for… more
- AmeriHealth Caritas (Newark, DE)
- …at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the administrative tasks ... to management + Monitors to ensure that all problems with appeals/ grievances presented by plan members/participants are resolved in accordance with established… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the...function is to learn the specialty level appeals and grievances work supporting the higher level position in this… more
- Texas Health Resources (Dallas, TX)
- Complaints and Grievances Program Manager - THPG _Texas Health Physicians Group is looking for a top skilled_ Complaints and Grievances Program Manager _. Is ... and support evidenced-based practices. Support and manage policies related to complaints/ grievances . Manage Grievance Events related to clinical care Identify and… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA-Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the Appeals ... and Grievances department through many NCQA and other related quality...+ Associate's Degree or equivalent experience in Appeals and Grievances **Desired Education:** + Bachelor's Degree (BS or BA)… more
- Humana (Baton Rouge, LA)
- …a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support… more
- Molina Healthcare (WI)
- …for the comprehensive research and resolution of the appeals, dispute, grievances , and/or complaints from Molina members, providers and related outside agencies ... internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests… 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, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I(Temp) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals & Grievance… more
- UPMC (Pittsburgh, PA)
- …Medicine Physician with a Pennsylvania Medical License for a Medical Director, Grievances role with UPMC Community Health Choices. This role is fully remote ... weekly availability within the aforementioned time frame. The Medical Director, Grievances is responsible for assuring physician commitment and delivery of… more
- Healthfirst (NY)
- …+ Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization management/case management. + ... Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as… more
- Evolent (Phoenix, AZ)
- …Stay for the culture. **What You'll Be Doing:** The **Coordinator** **,** **Appeals and Grievances ** at Evolent will serve as a point of contact for processing post ... determination reviews and appeals requests in accordance with departmental policies, regulatory requirements, and client contractual agreements. **Collaboration Opportunities** : The Specialty Appeals Team offers candidates the opportunity to make a meaningful… more
- Molina Healthcare (Austin, TX)
- …Determines appropriate language for letters and prepare responses to appeals and grievances . + Elevates appropriate appeals to the Appeals Specialist. + Generates ... and mails denial letters. + Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner. + Creates and/or maintains statistics and reporting. + Works with provider & member services to resolve balance bill issues… more
- Humana (Honolulu, HI)
- …+ MD or DO degree + A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of ... assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be… more
- Humana (Topeka, KS)
- …+ MD or DO degree + A current and unrestricted license in at least one state and willing to obtain license, as required, for various states in region of assignment + ... Board Certified in an approved ABMS Medical Specialty + **Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, or Physical Medicine and Rehab, Anesthesiology and General Surgery trained** + Excellent written and communication skills… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA-Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances team ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally,...member outreach as well as supports the Appeal and Grievances team in creation, review and mailing of member… more
- Virginia Mason Franciscan Health (Seattle, WA)
- …responsible for coordinating and tracking the timely resolution of customer complaints/ grievances for the assigned Virginia Mason Franciscan Health (VMFH) entity in ... parties and the appropriate department management to facilitate resolution of grievances , complaints and/or other issues concerning the quality of care and… more
- Elevance Health (Walnut Creek, CA)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, regulatory ... quality of care issues to include executive and regulatory grievances . **How you will make an impact:** +...an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and… more