- 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
- Elevance Health (Seattle, WA)
- …**Expected Work Hours:** Monday-Friday; 8am-5pm PST The ** Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and ... ** Manager II Grievance/ Appeals (RN)** **Location** :... departmental units to investigate, resolve, and respond to grievances and appeals , manages inventory and production… 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
- CareFirst (Baltimore, MD)
- …process with dynamic goals resulting in the full and fair review of appeals and grievances designed to achieve corporate objectives and advance departmental ... and accreditation requirements. Ensures appropriate and complete resolution of appeals , Regulatory complaints and External review requests. Performs analytics and… more
- Elevance Health (Mason, 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
- Fallon Health (Worcester, MA)
- …NCQA standards, other applicable regulatory requirements and member expectations. The FH Member Appeals & Grievances Coordinator serves to administer the FH ... departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Coordinator serves as a...calendar or at the direction of a supervisor or manager . Answers telephone calls via ACD queue, as needed,… 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
- University of Delaware (Newark, DE)
- Manager , Employee & Labor Relations Job no: 501883 College / VP Area:Office of Human Resources Work type: Staff Location: Newark/Hybrid Categories: Human Resources, ... Director, Employee and Labor Relations, the Employee and Labor Relations Manager , is responsible for managing day-to-day employee and labor relations functions.… more
- State of Colorado (Pueblo County, CO)
- CDOC - Release Case Manager (LVCF) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4969762) Apply CDOC - Release Case Manager (LVCF) ... and Supervision, Individualized Program Instruction/Tutoring, Multi-Disciplinary Staffing, Responding to Grievances and Resolving Issues of incarcerated individuals, Housing Placement… more
- Navy Exchange Services (NEX) (Bethesda, MD)
- …discipline. Provides guidance and assistance to management on disciplinary actions, grievances , and appeals . Ensures appropriateness of charges and penalties. ... Title: DISTRICT HUMAN RESOURCES MANAGER Location: United States-Maryland-Bethesda Job Number: 250001QP Job Summary: Provides senior level HR management for a large… more
- Roper St. Francis (Charleston, SC)
- …legal field, customer service or healthcare preferred. Prior experience working with grievances and appeals strongly preferred. Knowledge of RSFH organizational ... Summary** **:** The Patient Relations & Legal Coordinator aids in complaints and grievances management as well as legal matters to include coordinating with outside… 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
- Skookum Contract Services (Colorado Springs, CO)
- …same. + Investigate, prepare documentation, and recommend Tessera's position on grievances , complaints, and appeals . Responds to employee relation issues ... with union officials and adheres to terms of labor contract by supporting Manager in the day-to-day implementation of policies concerning wages, hours, and working… more
- Washington Metropolitan Area Transit Authority (New Carrollton, MD)
- Contract Manager Job ID: 250479 Location: MD-Metro Bldg New Carrollton Full/Part Time: Full-Time Posting Open-Close 06/04/2025 - 07/03/2025 Union NRP ... the National Contract Management Association (NCMA), the Certified Professional Contracts Manager (CPCM) or an appropriate certificate from a program sponsored by… 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
- State of Colorado (Denver, CO)
- …plans, and conducts performance evaluations; resolves informal staff and/or inmate grievances . Assigns tasks, monitors and inspects work progress and ensures ... inmate hours and pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness, and creates real life… more
- Elevance Health (Indianapolis, IN)
- …Dental, Transportation) strongly preferred + Experience with Medicaid and Medicare grievances and appeals processes + Experience with network development ... Alternate locations may be considered.** **Position Overview:** The Vendor Implementation Manager is responsible for Provider Network 3rd party delegated dental,… more
- CareOregon (Portland, OR)
- …and collaborator with multiple teams including provider customer service, claims, appeals and grievances , population health, information systems, and others. ... Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Clinical Operations Manager Department Clinical Operations Exemption Status Exempt Requisition # 24994… more
- UCLA Health (Los Angeles, CA)
- …compliance-driven projects across multiple functional areas including Quality Management, Appeals & Grievances , Credentialing, Member Services, Provider ... Description UCLA Health is seeking a Program Manager to join the Managed Care Operations team....key liaison to internal and external stakeholders. The Program Manager will manage timelines, resolve issues, and ensure operational… more
- Guardian Life (Holmdel, NJ)
- …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
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