- 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
- 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 ... standards. The Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals &… 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
- Elevance Health (Cerritos, 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 (Columbus, OH)
- …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
- 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...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
- Transdev (Dorchester, MA)
- …of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal requirements and ... Overview: Transdev in Boston, MA is seeking a Labor Relations Manager for its Boston Public Schools transportation contract. The Labor Relations Manager provides… more
- State of Colorado (Pueblo, CO)
- Nurse Manager - Mid Level Provider - CMHHIP Nursing- Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5171266) Apply Nurse Manager - ... as indicated in this announcement and if the hiring manager chooses to extend a job offer to you,...actions, signing performance plans and appraisals, and resolving informal grievances at the lowest level. + Draft and deliver… 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
- 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 ... daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints/ grievances at the informal level, responsibility for scheduling and… 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
- Elevance Health (Plainfield, 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 Daviess,...and direct, hands-on engagement. The **LTSS Service Coordinator (Case Manager )** is responsible for conducting service coordination functions for… more
- Sanford Health (Rapid City, SD)
- …and interaction with payers. Additional duties include management of medical denials, appeals , and grievances . Understand and provide insight into evaluating ... Details** Join our team as a Utilization Review and Case Management Manager and lead a high-impact, data-driven program that elevates patient outcomes while… more
- Elevance Health (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 )** **Candidates should live in one of the...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Guardian Life (Phoenix, AZ)
- …contact for all assigned DSOs. Respond to provider inquiries, concerns, complaints, appeals and grievances within assigned timeframes. Collaborate across teams ... to Dental Support Organization (DSO) partners. As a **Key DSO Dental Account Manager , Dental Support Organizations** , you will be responsible for growing the… more
- State of Colorado (Canon City, CO)
- …reviews, and completing performance evaluations per CDOC regulations, and resolves complaints/ grievances at the informal level; + Ensures staff compliance with the ... daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints/ grievances at the informal level, responsibility for scheduling and… 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
- Sharecare (Albany, NY)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances / appeals , utilization management (UM) status, including but not limited to ... payers or 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management...Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide +… more
- Tufts Medicine (Boston, MA)
- …a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee Relations ... reports when necessary. 4. Provides support to Workplace Investigation Manager when conducting complex internal investigations related to discrimination, harassment,… more
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