- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances ... support the safety net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General Operations (Clinical) is responsible… 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 ... that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage process… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... Appeals & Grievances Location: Los Angeles, CA,...Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type:...Specialist II is responsible for assisting the Appeal and Grievances Compliance, Training and QA Manager to… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I(Temp) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the...staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in… more
- Elevance Health (Walnut Creek, CA)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, ... an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Tampa, FL)
- …or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + ... skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances...clerical/administrative responsibilities at the discretion of the Director or Manager . * Providing administrative assistance in support of the… more
- CUNY (Brooklyn, NY)
- …Rules); tracking student conduct reports; coordinating the student conduct process, grievances , and appeals . + Oversee the Faculty Student Disciplinary ... Manager of Student Advocacy and Accountability (HEA) **POSITION...intervention student support service process, the resolution of student grievances , appeals , and complaints, and the utilization… more
- State of Colorado (Denver, CO)
- Essential Safety Net Licensing Manager Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5058003) Apply Essential Safety Net Licensing ... Manager Salary $71,544.00 - $93,024.00 Annually Location Denver, CO...as requested to the BHA Advisory Council on provider grievances , quality data, or other items as appropriate. Policy,… more
- Transdev (North Las Vegas, NV)
- …abreast of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Work with Internal and outside ... Labor Relations Manager The Labor Relations Manager provides...the grievance process and provide comprehensive responses to complaints, grievances , and arbitrations that support the Company's decision and… more
- State of Colorado (Pueblo, CO)
- Division of Facilities Management - Project Manager II - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5048646) Apply Division of ... Facilities Management - Project Manager II - Pueblo Salary $91,320.00 - $118,728.00 Annually...staff are trained to perform successfully. + Facilitates employee grievances . + Begins the hiring process, interviews applicants, and… more
- CVS Health (Springfield, IL)
- …each and every day. **Position Summary** The Medicaid Network Provider Relations Manager oversees our Medicaid Provider Experience programs to oversee and maintain ... building. + Coordinate with Network Management to issue provider CAP + Monitor Grievances according NCQA standards categories (3 grievances per QTR), including… more
- CHS (Clearwater, FL)
- …client trust. * Investigates and participates in formal responses relating to complaints, grievances and appeals received by or applicable to PAS. Participates ... **Overview** **Claims Manager ** **Servicing** **Health Insurance Policies or Benefits** **Summary:**...stated coverage. Join Premier Administrative Solutions as a Claims Manager and lead our Claims Department in delivering exceptional… more
- LA Care Health Plan (Los Angeles, CA)
- …Functional knowledge of Membership Eligibility and Enrollment, Member Maintenance, PCP assignment, Appeals and Grievances preferred. EDI 5 years of EDI Domain ... Technical Applications Manager II Job Category: Information Technology Department: IT...to achieve that purpose. Job Summary The Technical Application Manager II reports to the Senior Manager … more
- Veterans Affairs, Veterans Health Administration (Brockton, MA)
- …Resolve simple, informal complaints of employees and refer others, such as formal grievances and appeals , to the supervisor or an appropriate management ... Summary The Lead Safety and Occupational Health Manager position is in Engineering service for VA Boston Healthcare System located at Brockton, MA. This position is… more
- Elevance Health (IN)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + BA/BS degree ... **LTSS Service Coordinator (Case Manager )** **Location:** Seeking candidates to work in Bartholomew...and direct, hands-on engagement. The **LTSS Service Coordinator (Case Manager )** is responsible for conducting service coordination functions for… more
- Elevance Health (Dayton, OH)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... **LTSS Service Coordinator (Case Manager )** **Hiring statewide across Ohio** **Location** : This...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Humana (Springfield, IL)
- … Manager , and Medical Director) and departments to address and resolve member grievances and appeals . + Oversees the interface with the Enrollment Broker ... referrals, self-referral services, preventive and enhanced services, and member grievances and appeals procedures + In close coordination with other key staff,… more
- LA Care Health Plan (Los Angeles, CA)
- …due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters to ... collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory… more
- New York State Civil Service (Albany, NY)
- …issues.* Assisting in providing advice and consultation to supervisors, manager , directors, and Executives ensuring proper interpretation and administration of ... contract provisions relating to employee grievances or issues.* Assisting in the administration of the...issues involved, preparing EHS-707 and supporting referral data; managing appeals process for Section 72 appeals , including… more
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