- Insight Global (Tustin, CA)
- Job Description An employer is looking for a remote Appeals & Grievances Coordinator who will be responsible for managing and resolving appeals and ... teams and external stakeholders. Key Responsibilities - Review, research, and process appeals and grievances in compliance with company policies and regulatory… 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: ... safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- Sanford Health (Sioux Falls, SD)
- …governing appeals and grievance resolution. Lead and manage the end-to-end appeals and grievances process for all product lines, ensuring compliance with ... Oversee the intake, review, resolution, and documentation of all appeals , complaints, and grievances to meet regulatory...and documentation of all appeals , complaints, and grievances to meet regulatory and operational standards. Ensure all… 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: ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty level … more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a… 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: ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
- Point32Health (MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... to organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple requirements/regulations… more
- Molina Healthcare (Tampa, FL)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Dignity Health (Rancho Cordova, CA)
- **Job Summary and Responsibilities** The Appeals and Grievances LVN is a critical role responsible for managing and resolving all medical necessity appeal ... and maintaining patient confidentiality (HIPAA) are also essential. Ultimately, the Appeals and Grievances Nurse monitors denial trends, recommends corrective… more
- Point32Health (Canton, MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals ...Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and… more
- Modivcare (Ridgeland, MS)
- …opportunity may be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is responsible ... for service failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately provide a… more
- Fallon Health (Worcester, MA)
- …other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH ... The Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals & Grievances … more
- Elevance Health (Columbus, OH)
- …or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + ... + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non clinical… more
- Elevance Health (Mason, OH)
- …providers, and regulatory entities, and serves as a subject matter expert for appeals , grievances , and quality of care issues. .Key responsibilities: serves as ... **Nurse Appeals -Licensed Nurse** **Location** : Ohio, candidates must...and is dependent on court hearing schedules. The Nurse Appeals is responsible for investigating and processing and medical… more
- Centene Corporation (Indianapolis, IN)
- …and authorization appeals from providers and pursue resolution of formal grievances from members. + Gather, analyze and report verbal and written member and ... provider complaints, grievances and appeals + Prepare response letters for member and provider complaints, grievances and appeals + Maintain files on… more
- CareFirst (Baltimore, MD)
- …for collecting, organizing and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources. We are ... professional written and verbal communications to assist in responses of all appeals and/or grievances based on State and Federal requirements for all lines of… more
- Henry Ford Health System (Troy, MI)
- …for the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare ... AND RESPONSIBILITIES: + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center for… more
- CVS Health (Baton Rouge, LA)
- …**Position 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… more
- CVS Health (Baton Rouge, LA)
- …Must reside in Louisiana Responsible for intake, investigation and resolution of appeals , complaints and grievances scenarios for all products, which may ... responses from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance. Identify trends and emerging issues and report… more
- Centene Corporation (Phoenix, AZ)
- …appeals from providers and members. Resolve all State inquires related to complaints, grievances and appeals . + Review and process member and provider ... grievances and appeals within federal, state and organizational regulations and policies...appeal decisions. + Act as subject matter expert regarding grievances and appeals . + Lead Appeals… more
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