- Harbor Health Services, Inc. (Mattapan, MA)
- …process improvement, communication to employees about QI efforts. Working with the Appeals and Grievances Specialist, maintains oversight of the Grievances and ... Appeals process, including timely investigations, responses, and reporting to...of decisions. Supervisory responsibilities for UM RN, Quality Analyst, Appeals and Grievances Specialist. Requirements: Bachelor's Degree required, Nursing… more
- Whitney M Young (Albany, NY)
- …Development Officer, this role assists in the strategy and execution of appeals , digital campaigns, phone-a-thons, and donor stewardship to meet defined revenue ... & Execution Build and manage a 12-month annual giving calendar (spring/fall appeals , GivingTuesday, year-end, monthly giving pushes) aligned to revenue goals. Lead… more
- State Bar of Texas (Houston, TX)
- …before District Grievance Committees, District Courts, and the Board of Disciplinary Appeals . Involves frequent contact with State Bar departments, as well as with ... committee, district court trials and proceedings before the Board of Disciplinary Appeals . Negotiates and evaluates settlement offers on behalf of the Commission for… more
- Skidmore College (Saratoga Springs, NY)
- …Fund Direct Marketing to create a direct marketing plan (print and electronic appeals , social media) that ties into the overall Skidmore Fund direct marketing ... program. Identify, recruit, train, mentor, and support a team of fundraising volunteers. Analyze data, trends, and best practices to strengthen and grow Skidmore's efforts. Serve as a primary contact for volunteer chair(s). Assist with logistical operations… more
- Community Health of Central Washington (Yakima, WA)
- …If teaching, caring for the underserved, and living in the Pacific Northwest appeals to you, please submit Provider Pre Application (Provider Pre Application is ... available ), Letter of Interest and CV to: CHCW - ATTN: Terrie Jonas, 501 S 5th Ave., Yakima, WA 98902 or email to . more
- Point32Health (FL)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- University of Michigan (Ann Arbor, MI)
- Utilization Rev Appeals Spec Apply Now **Job Summary** **Why Join Michigan Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and ... knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will collaborate with multiple departments to maintain compliance… more
- 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 ... required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is...(Clinical) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals … more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd Street-Full-Time-Days -Remote** The Director, Pre Appeals ... who provides strategic leadership and operational oversight for the hospital's pre- appeals management program. This role ensures the appropriate use of medical… more
- Sanford Health (Sioux Falls, SD)
- …oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, including ACA, ... ensures adherence to all state, federal, CMS, HHS, and quality regulations governing appeals and grievance resolution. Lead and manage the end-to-end appeals and… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Henry Ford Health System (Troy, MI)
- RN PROVIDER APPEALS COORDINATOR - MEDICAL APPEALS - 40 HOURS WEEKLY - DAY SHIFT Full Time Benefit Eligible Schedule: Monday through Friday, 8:00AM to 4:30PM. ... Alliance Plan (HAP) is looking to grow our Medical Appeals Team with an experienced Registered Nurse! We are...and counting) and Utilization Review Coordinators (4) that review appeals for medical necessity using established medical criteria ,… more
- Point32Health (MA)
- …. **Job Summary** SUMMARY Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- Elevance Health (FL)
- **Nurse Appeals - Litigation & Legal Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, with ... and is dependent on court hearing schedules. The **Nurse Appeals - Litigation & Legal Support** is responsible for...is responsible for investigating and processing and medical necessity appeals requests from members and providers. **How You Will… more
- University of Washington (Seattle, WA)
- …Patient Financial Services Department** has an outstanding opportunity for a **Clinical Appeals and Disputes Nurse.** **WORK SCHEDULE** + 100% FTE + 100% Remote ... + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared to reimburse the UW Medicine for services in accordance with… more
- CVS Health (Frankfort, KY)
- …Summary** Coordinate effective resolution of member and/or provider/practitioner appeals , complaints and grievances. Responsible for the day-to-day management ... of staff to ensure effective resolution of member or provider/practitioner appeals , complaints and grievances for all products, which may contain multiple issues… more
- Centene Corporation (Jefferson City, MO)
- …medical directors and supervise MD's responsible for utilization management and appeals functions to ensure members receive medically necessary, evidence-based care ... the enterprise. + Provide medical leadership for all utilization management ( appeals ), pharmacy, case management, disease management, cost containment, and medical… 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 ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to...I primary function is to learn the specialty level appeals and grievances work supporting the higher level position… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... 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
