- Point32Health (Canton, MA)
- …(https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the VP, the Appeals and Grievances Director is responsible for management ... and oversight of the Enterprise Member Appeals and Grievances Department. The Director is responsible for all aspects of the member appeals and grievance… more
- Elevance Health (Costa Mesa, CA)
- …appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + Documents ... entities. + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non… more
- Elevance Health (Los Angeles, CA)
- …appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + Documents ... entities. + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non… more
- Elevance Health (Brentwood, TN)
- …appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + Documents ... entities. + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides… more
- Humana (Columbus, OH)
- … Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services… more
- Universal Health Services (Reno, NV)
- …review, research, processing and responding to written member and provider complaints, appeals , and grievances . This position is required to apply analytical ... Department Manager. Job Duties/Responsibilities: + Responsible for receiving all member appeals and setting up files. Initiates telephone calls to obtain information… more
- Elevance Health (Woburn, MA)
- …you will make an impact:** + Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues. ... medical staff or outside consultant. + Triages clinical and non-clinical inquiries, grievances and appeals , prepares case files for member grievance… more
- Pacific Medical Centers (Seattle, WA)
- …appeals for presentation. Decision maker for all post service, network and benefit appeals . Acts as second level manager for grievances . Works with patients ... **Description** **Overview:** The director provides leadership for USFHP clinical operations: including...presentation. Decision maker for all post-services, network and benefit appeals . Acts as second-level manager for grievances .… more
- Gwinnett County Public Schools (Suwanee, GA)
- …of Employee Relations will assist in providing resolution in matters related to grievances and appeals , training and development to administrators and employees ... Director Employee Relations - Office of Employee Relations...on equity, compliance, accommodation, grievances , and Title IX.1. Leads equal opportunity and other… more
- Gwinnett County Public Schools (Suwanee, GA)
- …Employee Relations and Compliance provides employees direction in matters related to grievances and appeals , and provides training and development to ... Executive Director of Employee Relations and Compliance - Office...administrators and employees on equity, compliance, accommodation, and grievances .1. Assign and direct the equalopportunity and other law… more
- CVS Health (Columbus, OH)
- …Fair Hearings as needed. Understand UM and participate in UM front line work and appeals as needed in OH and other markets as needed* Confer directly with providers ... illnesses through peer review and educational interventions.* Work with medical director teams focusing on inpatient care management, clinical coverage review,… more
- Molina Healthcare (Detroit, MI)
- …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- Molina Healthcare (Long Beach, CA)
- …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- UPMC (Moosic, PA)
- We have an exciting opportunity for a full-time Senior Medical Director to join our leadership team with UPMC Community Care! As Senior Medical Director , you ... to learn more and apply today! The Senior Medical Director provides guidance for clinical operational aspects of the...with the Counties and DHS + Reviews complaints and grievances in accordance with Community Care procedures and ensures… more
- New York University (NY)
- …of Professional Studies seeks a Clinical Assistant/Associate/Full Professor and Academic Director for the Schack Institute of Real Estate, effective Fall 2024. ... of Real Estate, the successful candidate will also serve as the Academic Director to implement the vision for expanding Schack's real estate programs and… more
- Thomas Edison State University (Trenton, NJ)
- …and faculty deployment. -Respond to student concerns to resolve conflicts, appeals , and disputes/ grievances . -Assist with preparation of self-study report ... **Family Nurse Practitioner (FNP) Program Director ** **D30** Thomas Edison State University was founded...opportunities, should submit an application. **Summary:** The FNP Program Director reports directly to the Dean, W. Cary Edwards… more
- AdventHealth (Maitland, FL)
- …makes recommendations on appealed provider claims and makes determinations for appeals & grievances from members.Provides support, shares administrative call, ... **The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members of the Case… more
- Highmark Health (Charleston, WV)
- …to enrollment, access and continuity of care issues, support members throughout any grievances or appeals activities, assist members in obtaining materials in ... promotion incentive programs offered by the health plan. + Grievances and Appeals Process + Assist the...and internal action effecting customer satisfaction. + Assist the Director of Member Experience in the development and implementation… more