- CVS Health (Baton Rouge, LA)
- …from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Responsible for day-to-day implementation of ... case load including but not limited to: -Research incoming electronic appeals , complaints and grievance to identify if appropriate for unit based upon published… 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 ... an 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 (Mason, OH)
- …by medical directors and consultants; preparing recommendations to uphold or deny appeals ; and ensuring all grievance processes are completed within regulatory ... and/or paralegal experience is strongly desired. .Understanding of the grievance and appeals process is strongly preferred....Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… 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 ... net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General...and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best… more
- Elevance Health (Columbus, OH)
- **Nurse Appeals RN** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Fields _(Must be within commutable distance to the listed locations.)_ **Virtual:** ... unless an accommodation is granted as required by law._ The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... FH Appeals and Grievances Triage Administrator serves to administer the FH Appeals and Grievance process as outlined in the FH Member Handbook/Evidence of… more
- Transdev (Dorchester, 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
- CVS Health (Annapolis, MD)
- … partners cross-functionally with Provider Relations, Configuration, Compliance, Finance, Appeals and Grievance . and Medical Management. **Key Responsibilities** ... do it all with heart, each and every day. **Position Summary** The Manager of Claims Management is responsible for overseeing Medicaid claims operations, inventory… more
- CVS Health (Hartford, CT)
- …(PO) is responsible for leading the MHK product development and configuration for the Grievance & Appeals (G&A) Department. This role contributes to the product ... solution. + Ensures requirements are signed by the Value Stream Lead and Product Manager . + Communicate business requirements with DDAT in order for the DDAT team to… more
- Tufts Medicine (Boston, MA)
- …involving a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee ... reports when necessary. 4. Provides support to Workplace Investigation Manager when conducting complex internal investigations related to discrimination, harassment,… more
- CVS Health (St. Paul, MN)
- …obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. + Coordinates provider status information ... with member services and other internal departments. + Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions. +… more
- LA Care Health Plan (Los Angeles, CA)
- …all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters ... collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory… more
- State of Colorado (Canon City, CO)
- …at the informal level; + Ensures staff compliance with the offender grievance process, offender co-pay, electronic data entry, and information systems requirements; ... establish an eligible list for referral to the hiring manager for final consideration. Use of artificial intelligence (AI)...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Elevance Health (Miami, FL)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations....Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CVS Health (Trenton, NJ)
- …obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. Coordinates provider status information ... and every day. **Position Summary** + The Medicaid VBS Network State Manager manages and oversees compliance with our Network responsibilities as provided within… more
- State of Colorado (CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... establish an eligible list for referral to the hiring manager for final consideration. Be sure the "Work Experience"...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …referrals generated to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department ... functions assigned to non-care managers are monitored by the care manager + The care manager provides feedback to the non-care manager 's supervisor, as… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …and Management Team + Legal Department: + Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare Advantage, and InterPlan Program) + ... CPR's Director and Clinical Lead, Operations Lead, Senior Credentialing Manager / Compliance Consultant, Risk Specialist, Exception Review Specialists and Project… more
- Elevance Health (New York, NY)
- …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
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