- Cleveland Institute of Music (Cleveland, OH)
- …personnel records. Maintains all job descriptions and review annually with manager . Conducts new hire orientation, training, employee recognition and wellness ... Provides guidance, attends and participates in employee disciplinary meetings, grievances (union and non-union related), terminations, and investigations (not Title… 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 ... support the safety net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General Operations (Clinical) is responsible… more
- Molina Healthcare (Houston, TX)
- …* Manages team responsible for the submission/resolution of member and provider appeals and grievances ; ensures resolutions are compliant with applicable ... call tracking system of correspondence and outcomes for provider and member appeals / grievances ; oversees/monitors appeals to ensure all internal and… 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
- Elevance Health (South Portland, ME)
- …analyzing and processing non-complex and some complex pre service and post service grievances and appeals requests in the Enterprise Grievance & Appeals ... + The analyst may serve as a liaison between grievances & appeals and /or medical management,...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CareFirst (Baltimore, MD)
- …educational and training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in the development and ... data related to the volume and complexity of the appeals and grievances submitted for resolution. **SUPERVISORY...Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred + LNCC - Legal Nurse… more
- Molina Healthcare (AZ)
- …Design scalable workflows and controls across intake, adjudication, adjustments, appeals / grievances , and payment integrity. + Technology Enablement: Oversee ... understanding of claims lifecycle, EDI transactions, payment integrity, provider data, appeals / grievances , and audit/compliance (CMS, HIPAA, NCQA, state regs). +… 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
- State of Colorado (Fremont County, CO)
- CDOC - Correction Case Manager I (CCF) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5131315) Apply CDOC - Correction Case Manager I ... Supervision, Individualized Program Instruction/Tutoring, Multi-Disciplinary Staffing, Responding to Offender Grievances and Resolving Offender Issues, Offender Housing Placement and… more
- Elevance Health (Washington, DC)
- …locating services and maintaining eligibility in a timely fashion, resolving Enrollee Grievances , assisting Enrollees to file and pursue Appeals involving the ... be familiar with Salesforce + Experience with Tableau strongly preferred + Grievances and appeals experience strongly preferred + Enrollee Services experience… more
- State of Colorado (Pueblo, CO)
- Relief Pool and Ambulatory Clinic Manager - Mid Level Provider - CMHHIP Nursing- Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5137227) ... Apply Relief Pool and Ambulatory Clinic Manager - Mid Level Provider - CMHHIP Nursing- Pueblo...actions, signing performance plans and appraisals, and resolving informal grievances at the lowest level. + Draft and deliver… 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/5137471) 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
- 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: 250003EY Job Summary: Provides senior level HR management for a large… 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
- J&J Family of Companies (Los Angeles, CA)
- …such as eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ; practice management, as well as Medicare and ... Innovative Medicine is recruiting for a Senior Regional Business Manager , Site of Care, to lead the West Coast...more at https://www.jnj.com/innovative-medicine The role of the Regional Business Manager is to expand the sales of the Immunology… 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 Greene,...and direct, hands-on engagement. The **LTSS Service Coordinator (Case Manager )** is responsible for conducting service coordination functions for… 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 (Cambridge, 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 near Ashland, Bucyrus, Cadiz, Cambridge, Coshocton,...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
