- RestoraCare Staffing (Houston, TX)
- …per case, excess days, resource utilization, readmission rates, denials and appeals . Uses data to drive decisions and plan/implement performance improvement ... strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data. Collects, analyzes and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team. Uses… more
- The Cigna Group (Nashville, TN)
- **Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst** We will depend on you to communicate some of our most critical information to the correct ... individuals regarding Medicare appeals and related issues, implications and decisions. The ...appeals and related issues, implications and decisions. The Appeals Processing Analyst reports to the Supervisor/Manager of … more
- Apex Health Solutions (Houston, TX)
- Job Title: Appeals & Grievances Coordinator Department: Appeals and Grievances Supervisor: Manager, Appeals & Grievances FLSA Status: Nonexempt Summary The ... focused on the processing of customer and provider Medicare and Commercial appeals and grievances. This associate may screen incoming complaints, process medical… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Appeals and Grievances General Operations (RN-Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is...(Clinical) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals … more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Supervisor, Customer Solution Center Appeals & Grievances is responsible for direct supervision and support of the… more
- Randstad US (Columbus, OH)
- grievance and appeals coordinator. + columbus , ohio + posted april 10, 2024 **job details** summary + $19.99 - $20 per hour + temp to perm + high school + category ... has an immediate opening for an experienced Grievance and Appeals Coordinator. This is a hybrid role located in...worked in after. Must be experienced with grievance and appeals , claim denials, medical terminology and CPT codes. If… more
- Federal Emergency Management Agency (Chicago, IL)
- Summary The ideal candidate has experience assisting with managing appeals processes while maintaining compliance and fostering positive stakeholder relationships. ... I do in this position if hired? In this Appeals Coordinator position, you will serve in the FEMA...Typical assignments include: Reviewing and processing first and second appeals received in Region V. Logging appeals … more
- CVS Health (Fresno, CA)
- …between 9am-1pm. Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more
- Point32Health (Canton, MA)
- …. **Job Summary** Under the general direction of the VP, the Appeals and Grievances Director is responsible for management and oversight of the ... Enterprise Member Appeals and Grievances Department. The Director is responsible for...Director is responsible for all aspects of the member appeals and grievance processes for all lines of business… more
- Universal Health Services (Reno, NV)
- …Job Summary: Under the direction of the Manager of Operations, the Appeals Specialist is responsible for ensuring the appropriate review, research, processing and ... responding to written member and provider complaints, appeals , and grievances. This position is required to apply analytical and critical thinking when reviewing… more
- Howard University Hospital (Washington, DC)
- …patient outcomes. Howard University Hospital seeks to hire an Denial and Appeals Coordinator who will embrace our reach and historic tradition of excellence. ... are doing just that, making a difference. The Denial and Appeals Coordinator: The Denial & Appeals Coordinator is responsible for denial and appeals claim… more
- Evolent Health (Columbus, OH)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Elevance Health (Palo Alto, CA)
- …you a check, or ask you for payment as part of consideration for employment. **Nurse Appeals CA (US)** + Job Family: MED > Licensed Nurse + Type: Full time + Date ... WALNUT CREEK + CA, PALO ALTO + CA, COSTA MESA **Description** **Nurse Appeals - California candidates only** **Location: This is a virtual position and prefer… more
- Elevance Health (Woodland Hills, CA)
- …a check, or ask you for payment as part of consideration for employment. **Grievances and Appeals Analyst I** + Job Family: CLM > Claims Support + Type: Full time + ... CA, WOODLAND HILLS + NV, LAS VEGAS **Description** **Title: Grievance/ Appeals Analyst I** **Location:** This position will work a...50 miles of one of our PulsePoint locations. The **Grievance/ Appeals Analyst I** is an entry level position in… more
- Elevance Health (Norfolk, VA)
- …you a check, or ask you for payment as part of consideration for employment. **Grievance/ Appeals Analyst I** + Job Family: CLM > Claims Support + Type: Full time + ... JR112696 **Location:** + VA, Norfolk + KY, Lexington **Description** **Title: Grievance/ Appeals Analyst I** **Location:** This position will work a hybrid model… more
- TEKsystems (Los Angeles, CA)
- Hiring for Grievance and appeals Coordinator Tek Systems is currently hiring for Healthcare program coordinators for one of top healthcare company in Florida. ... Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- Elevance Health (Walnut Creek, CA)
- …you for payment as part of consideration for employment. **Manager I - Grievance & Appeals - Provider Disputes** + Job Family: CLM > Claims Support + Type: Full time ... NV, LAS VEGAS **Description** **Manager I - Grievance & Appeals - Provider Disputes** **Location** : This position will...California or Nevada. The **Manager I - Grievance & Appeals ** is responsible for the management oversight of receipt,… more
- CVS Health (Hartford, CT)
- …residence. Position OverviewAdministers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical records to apply appropriate ... to implement best in class policies, plans, and procedures in support of the Appeals area objectives. + Executes review of all clinical and benefit documentation for… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
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