- 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 (Walnut Creek, 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
- 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
- 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
- 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
- Elevance Health (Tampa, FL)
- **Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... unless an accommodation is granted as required by law._ The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- Transdev (North Las Vegas, NV)
- Labor Relations Manager The Labor Relations Manager provides support to the Area General Manager , Director of Human Resources, and Operations Teams on labor ... ensure consistency in language and interpretation of collective bargaining agreements, grievance management, and arbitration preparation. Transdev is proud to offer:… 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
- CUNY (Brooklyn, NY)
- …assessment, BIT/student support case management, freedom of expression oversight, and grievance and appeals resolution. + Collaborate with various departments ... Manager of Student Advocacy and Accountability (HEA) **POSITION...conduct reports; coordinating the student conduct process, grievances, and appeals . + Oversee the Faculty Student Disciplinary Committee to… more
- MTA (Jamaica, NY)
- Senior Manager , Labor Relations Job ID: 12770 Business Unit: MTA Headquarters Location: Jamaica, NY, United States Regular/Temporary: Regular Department: Labor ... Posted: Aug 20, 2025 Description POSTING NO. 12770 JOB TITLE: Senior Manager , Labor Relations DEPT/DIV: Labor Relations WORK LOCATION: Jamaica, NY FULL/PART-TIME FUL… more
- CVS Health (Downers Grove, IL)
- …obtain crucial or required information from Providers, such as HEDIS, Revalidation, Grievance and Appeals , SIU, etc. Coordinate provider status information with ... Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and/or Network Performance Standards * Progressive leadership… more
- Humana (Springfield, IL)
- …with Medicaid or DSNP Members. + Knowledge and/or experience in working with grievance and appeals . + Intermediate to advanced knowledge of Microsoft Office ... strategies on matters of significance, and lead execution of member grievance and appeal trends, working closely with cross-departmental management. + Partners… 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
- Sharp HealthCare (San Diego, CA)
- …Chief Medical Officer and reports findings in conjunction with the Quality Improvement Manager . + Participates in the grievance process with the Chief Medical ... policy as needed. + Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager to identify trends… more
- Sharp HealthCare (San Diego, CA)
- …to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager to identify ... needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its'...data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources. + Achieves and maintains… more
- State of Colorado (Pueblo, 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
- New York State Civil Service (Albany, NY)
- …relations and employee relations.* Assisting in scheduling and conducting grievance meetings, investigations, interviewing, interrogations to identify and report ... issues.* Assisting in providing advice and consultation to supervisors, manager , directors, and Executives ensuring proper interpretation and administration of… 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
- Washington Suburban Sanitary Commission (WSSC) (Laurel, MD)
- …and/or outside the scope of Police & Homeland Security Division. . Manages the grievance and appeals process for both union and non-union employees. . Ensures ... Job CodeN/A Job Description Summary Organization NameHuman Resources Office Reports toSection Manager , Employee & Labor Relations Full or Part TimeFull Time If Part… more
- Elevance Health (Atlanta, GA)
- …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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