- Denver Health (Denver, CO)
- …for all Plan lines of business. (5%) Consults and communicates effectively with Appeals Manager , senior leaders and other departments in the investigation and ... We are recruiting for a motivated RN Health Plan Grievance & Appeals Specialist - Denver Health Medical Plan (Must Be a Colorado Resident) to join our team! We… more
- Mount Sinai Medical Center (Miami Beach, FL)
- Care Management Business Operations Manager As Mount Sinai grows, so does our legacy in high-quality health care. Since 1949, Mount Sinai Medical Center has remained ... who are involved in the denial management process to ensure that denials and appeals are tracked, trended, and reported to the Director regularly Is familiar with… more
- EmblemHealth (New York, NY)
- Summary of Position Perform clinical and administrative reviews within the Grievance and Appeals department, ensuring accurate administration of benefits, ... timely and professional manner. Maintain an understanding of utilization management/ grievance and appeals program objectives and design, implementation,… more
- Alameda Alliance For Health (Alameda, CA)
- …are resolved by the next business day following receipt). Interface with Grievance and Appeals , Claims, Enrollment, IT, Network Management, Pharmacy, ... Member Services Representatives are under the direction of a Member Services Supervisor, Manager and Director, and service our members through our call center as… more
- Blue Shield of California (Rancho Cordova, CA)
- …plan type Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD) Recognize the clients right to ... The Case Management Nurse, Senior will report to the Manager , Care Management. In this role you will determine,...Science in Nursing or advanced degree preferred Certified Case Manager (CCM) Certification or is in process of completing… more
- PacificSource (Springfield, OR)
- …expertise for physical, behavioral, and oral health utilization management, and grievance and appeals . As appropriate, interface with appropriate regulatory ... Management departments and activities. As assigned, participate in relevant Manager /Supervisor meetings including meetings related to Population health, Provider… more
- Blue Shield of California (Long Beach, CA)
- …plan type Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD) Recognize the clients right to ... 9:30-6:00 Your Role The Behavioral Health Registered Nurse Case Manager will report to the FEP Department Manager... Manager will report to the FEP Department Manager . In this role you will determine, develop, and… more
- Elevance Health (Chicago, IL)
- …necessity determinations for services requested. Makes medical necessity determinations for grievance and appeals appropriate for their specialty. Ensures ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- LA Care Health Plan (Los Angeles, CA)
- …required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory ... clarification on initial responses. (25%) Under the supervision of the Appeals and Grievance Manager , assist with soliciting non-clinical information from… more
- Elevance Health (Durham, NC)
- ** Manager II Grievance / Appeals ** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... unless an accommodation is granted as required by law._ The ** Manager II Grievance / Appeals ** responsible for management oversight of grievances and … more
- Elevance Health (Cerritos, CA)
- **Title: Grievance / Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... accommodation is granted as required by law._ " The ** Grievance / Appeals Analyst I** is an entry level...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Columbus, GA)
- ** Grievance / Appeals Analyst Senior** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... onboarding and skill development. Shift hours: 8:00am - 4:30pm EST** The ** Grievance / Appeals Analyst Senior** is responsible for reviewing, analyzing, and… 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, ... net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances...5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health… more
- Molina Healthcare (San Antonio, TX)
- …years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, including 2 years in a manager role. * Experience ... Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member… more
- Molina Healthcare (St. Petersburg, FL)
- …7 years experience in healthcare claims review and/or member appeals and grievance processing/resolution, including 3 years in a manager role. * Experience ... for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and resolving member and… more
- LA Care Health Plan (Los Angeles, CA)
- …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and cohesive unit with...the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB… more
- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the direction of the A&G Manager , the Appeals & Grievances QA Auditor audits the quality ... of letters and keyed entries from the Grievance and Appeals systems. Checks cases built by other associates to ensure highest level of quality and timeliness.… more
- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the general direction of the Manager , Appeals and Grievances the Supervisor, Appeals ... ensure all cases are processed timely. + Work with Manager to ensure that employees have the requisite information...+ Preferred: Experience + Required (minimum): 4-6 years of Appeals and Grievance experience.1-2 years of prior… more
- Elevance Health (Tampa, FL)
- **Nurse Appeals - Medicare** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... unless an accommodation is granted as required by law. The **Nurse Appeals - Medicare** is responsible for investigating and processing and medical necessity… more
- Transdev (Readville, MA)
- Overview: Transdev in Boston, MA is seeking a Labor Relations Manager for its Boston Public Schools transportation contract. The Labor Relations Manager provides ... Responsibilities: + Manage labor relations program of the property jointly with the General Manager . + Research, compile, and prepare data for use in grievance … more
