- Harbor Health Services, Inc. (Mattapan, MA)
- …process improvement, communication to employees about QI efforts. Working with the Appeals and Grievances Specialist, maintains oversight of the Grievances ... consistency of decisions. Supervisory responsibilities for UM RN, Quality Analyst, Appeals and Grievances Specialist. Requirements: Bachelor's Degree required,… 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: ... required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations...years of clinical acute care experience with at least 3 years of experience with health care grievance and/or… more
- Sanford Health (Sioux Falls, SD)
- … appeals and grievances , regulatory oversight, or health policy. At least 3 years in a leadership role managing appeals , grievances , or regulatory ... appeals and grievance resolution. Lead and manage the end-to-end appeals and grievances process for all product lines, ensuring compliance with federal 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
- Elevance Health (Cerritos, CA)
- …+ HS diploma or GED. + Minimum of 3 years experience working in grievances and appeals , claims, or customer service; or any combination of education and ... reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, regulatory and… 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 ... and verbal communications to assist in responses of all appeals and/or grievances based on State and...**QUALIFICATIONS:** **Education Level:** High School Diploma or GED. **Experience:** 3 years experience in settings such as managed care,… 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 ... + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from:...healthcare or a related field. + Minimum of three ( 3 ) years of experience in a Customer Service or… more
- State of Colorado (Canon City, CO)
- …interviews; schedules staffing patterns; approves training opportunities; and resolves complaints/ grievances at the informal level; + Trains and instructs staff ... or sales, project management and bidding projects . OR: A minimum of three ( 3 ) years of experience, as described above may be combined with experience in a… more
- City of New York (New York, NY)
- …United States law school as defined in the Rules of the New York Court of Appeals (Sections 520. 3 or 520.5) or admission to the New York State Bar. Additional ... AHED also represents NYCHA in remaining family member and rent grievances brought by public housing residents and Section 8 participants. Attorneys… more
- State of Colorado (Greeley, CO)
- …professional development training (as available). Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, ... interventions for all youth. Responds to and resolves youth grievances . Act as first public contact with agency when...should not disqualify the applicant from the current position, ( 3 ) provide the employee number from the applicant's prior… more
- CSEA (Albany, NY)
- …of Appeals , NYS DHR, EEOC, Child Abuse Registry; contract grievances and disciplinary arbitration under various state and local collective bargaining agreements; ... in numerous forums, including federal appellate court (Second Circuit, Court of Appeals ); state appellate court in the four departments of the Appellate Division;… more
- CVS Health (Tallahassee, FL)
- …needed and state calls. Understand UM and participate in UM front line work and appeals in markets as needed. * Confer directly with providers regarding the care of ... director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review, and provider appeals … more
- Tufts Medicine (Boston, MA)
- …of experience in Human Resources, Employee Relations, and Labor Relations. 3 . Certification in Human Resources. 4. Process improvement certification (eg, six-sigma). ... a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee Relations… more
- Washington Headquarters Services (Alexandria, VA)
- …related to: adverse and disciplinary actions associated with conduct, dispute resolution, grievances , Merit Systems Protection Board (MSPB) appeals , or Office of ... the Designated Agency Representative in fact finding, responding to negotiated grievances , and representing the Agency at arbitration hearings. Providing expert… more
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more
- Transdev (Dorchester, MA)
- …of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal requirements and ... (2) weeks + Sick days: 5 days + Holidays: 12 days; 9 standard and 3 floating + Other standard benefits: 401(k) retirement plan, medical, dental and vision, life… more
- MTA (New York, NY)
- …and participate in monthly conferences with union representatives to discuss contract grievances and employee discipline appeals ; perform analytical review of ... Authority is North America's largest transportation network, serving a population of 15. 3 million people across a 5,000-square-mile travel area surrounding New York… more
- Molina Healthcare (NM)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
- Molina Healthcare (Orem, UT)
- …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- State of Colorado (Golden, CO)
- …of CYSOIs. This position must maintain professional boundaries according to the Policy S- 3 -30 - Professional Conduct and the Policy S- 3 -20 - Relationships ... hygiene practice. Ensure that youth are provided confidential access to grievances , medical assistance and mental health assistance as needed/requested without staff… more
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