- Elevance Health (Seattle, WA)
- ** Manager II Grievance / Appeals (RN)** **Location** : **Hybrid 2:** This role requires associates to be in-office **3** days per week, fostering collaboration ... locations may be considered. **Expected Work Hours:** Monday-Friday; 8am-5pm PST The ** Manager II Grievance / Appeals ** is responsible for management oversight… more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Fallon Health (FH) Appeals and Grievance process is an essential function to FH compliance ... & Grievances Coordinator serves to administer the FH Appeals and Grievance process as outlined in...calendar or at the direction of a supervisor or manager . Answers telephone calls via ACD queue, as needed,… 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
- CareFirst (Baltimore, MD)
- …**ESSENTIAL FUNCTIONS:** + Develops, establishes and implements a compliant appeal, grievance and other member/provider type complaints process with dynamic goals ... resulting in the full and fair review of appeals and grievances designed to achieve corporate objectives and advance departmental capabilities. Accountable for… 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 (Mason, OH)
- **Nurse Appeals - Medicare** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... from Tuesday to Saturday and coverage on certain holidays. The **Nurse Appeals - Medicare** is responsible for investigating and processing and medical necessity… 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
- University of Delaware (Newark, DE)
- Manager , Employee & Labor Relations Job no: 501883 College / VP Area:Office of Human Resources Work type: Staff Location: Newark/Hybrid Categories: Human Resources, ... Director, Employee and Labor Relations, the Employee and Labor Relations Manager , is responsible for managing day-to-day employee and labor relations functions.… more
- MTA (Jamaica, NY)
- Senior Manager , Labor Relations & Arbitration Job ID: 11392 Business Unit: MTA Headquarters Location: Jamaica, NY, United States Regular/Temporary: Regular ... Date Posted: May 5, 2025 Description POSTING NO. 11392 JOB TITLE: Senior Manager , Labor Relations & Arbitration DEPT/DIV: Labor Relations WORK LOCATION: Jamaica, NY… more
- State of Colorado (Pueblo County, CO)
- CDOC - Release Case Manager (LVCF) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4969762) Apply CDOC - Release Case Manager (LVCF) ... opportunities for offenders to receive feedback, crisis intervention, and grievance resolution; + Complete and document offender contacts, transitional release… 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
- Skookum Contract Services (Colorado Springs, CO)
- …with union officials and adheres to terms of labor contract by supporting Manager in the day-to-day implementation of policies concerning wages, hours, and working ... relation issues and concerns, union issues, classification, performance management, grievance resolution, leave of absence coordination, disability accommodation(s), Fitness-for-duty… more
- Roper St. Francis (Charleston, SC)
- …resolutions, receives & forwards compliments, issues acknowledgement letters, forwards grievance forms within the designated timeframe, assists with accreditation ... or healthcare preferred. Prior experience working with grievances and appeals strongly preferred. Knowledge of RSFH organizational structure strongly preferred.… 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
- MyFlorida (Jacksonville, FL)
- …of incident reporting, fatality reviews and continuous quality improvement reports, grievance / appeals and use this information ito initiate regional ... substance use disorder programs as assigned by the Regional Licensing Manager in accordance with established guidelines. Identify any corrective actions plans… more
- Elevance Health (Cincinnati, OH)
- …including assessments, service planning, care coordination, transition planning, member appeals , state hearings, and member and caregiver education and training. ... in accordance with federal and state requirements, overseeing the member grievance process. + Work closely with Medical Officers, Quality Directors, Providers,… more
- Elevance Health (Seattle, WA)
- …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
- Elevance Health (Miami, FL)
- …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
- Somatus (Mclean, VA)
- …+ Oversee new client pre-delegation audits, annual client audits, development of grievance and appeals workflow processes, and other regulatory requirements. + ... Special Need Plans (SNPs). The Director, Quality will work closely with Sr. Manager , Audit Risk and the Regulatory and Accreditation Team to ensure compliance with… more
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