- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance ... of the Appeals and Grievances department through many NCQA... department through many NCQA and other related quality program activities including: monthly case quality monitoring, coordination of… more
- LA Care Health Plan (Los Angeles, CA)
- …care setting. Experience in health care auditing and monitoring (preferably in Appeals , Grievances , Quality Improvement, Utilization Management (UM) and so ... Compliance Advisor II Job Category: Administrative, HR, Business Professionals...maintain, and monitor Internal Compliance Committee (ICC) Charter, Compliance Program and key performance indicators. Responsible for the development… more
- Sharp HealthCare (San Diego, CA)
- …policy as needed. + Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify trends ... the membership. Serves as a medical manager and policy advisor to SHP and its Chief Medical Officer. Is...plan Chief Medical Officer) in short and long range program planning, total quality management (quality improvement), and external… more
- Sharp HealthCare (San Diego, CA)
- …to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify ... of care foundation for our NCQA required population health management program . Additionally, this position provides the representation of physician's insight,… more
- United States Fleet Forces Command (Naval Base, VA)
- …in the technical aspects of personnel administration during formal hearings, grievances , and appeals ; Experience applying labor relations and personnel ... problems and make sound recommendations to management. You will act as an advisor to management on difficult, complex and controversial matters. You will resolve… more
- University of Colorado (Aurora, CO)
- …and appeals processes and serve as a neutral party and advisor in faculty grievances , promotion disputes, performance reviews, and departmental conflicts. ... and engagement. + Develop key performance metrics to measure faculty affairs program success and guide data-driven decision-making. + Recommend and lead new faculty… more