- Elevance Health (Cerritos, CA)
- ** Manager II Grievance / Appeals - Claims Support** **Location: *CA Residential Requirement** This position will work a hybrid model (remote and office). Ideal ... 50 miles of one of our PulsePoint locations. The ** Manager II Grievance / Appeals ** is responsible... departmental units to investigate, resolve, and respond to client/ provider grievances/ appeals and ensure compliance with regulatory… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances...5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health… more
- Apex Health Solutions (Houston, TX)
- Job Title: Appeals & Grievances Coordinator Department: Appeals and Grievances Supervisor: Manager , Appeals & Grievances FLSA Status: Nonexempt Summary ... position is focused on the processing of customer and provider Medicare and Commercial appeals and grievances....a commitment to the Continuous Quality Improvement Process. The Appeals & Grievance Coordinator will interact on… more
- LA Care Health Plan (Los Angeles, CA)
- …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB… more
- CVS Health (Oklahoma City, OK)
- …Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards + ... health care more personal, convenient and affordable. Position Summary The Medicaid Sr. Manager , Provider Engagement manages and oversees compliance with our … more
- CVS Health (New York, NY)
- …Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards + ... more personal, convenient and affordable. Position Summary The Senior Manager of Provider Relations manages a team...of reports, attends, and presents at Plan committee meetings ( Grievance , SIC, etc.) + Coordinates provider information… more
- Highmark Health (Charleston, WV)
- …plan staff, to affect access to medical care and quality of medical care. + Provide input to HHO management on how provider network changes will affect member ... Process + Assist the member with the health plan's Grievance and Appeals process. + Attend all...to support the member as assigned. + Collaborate with Appeals & Grievances, Clinical Services, and Provider … more
- The Cigna Group (Bloomfield, CT)
- …regarding Medicare appeals and related issues, implications and decisions. The Appeals Reviewer reports to the Supervisor/ Manager of Appeals and ... **Cigna Healthcare Medicare Appeals Reviewer:** We will depend on you to...Medicaid regulations to determine the outcome of the appeal; provide oversight and assistance to Medical Management staff with… more
- Humana (Tallahassee, FL)
- …on continuous improvement in the areas of contributions, competencies and performance for the Grievance & Appeals Department. + Provide guidance, direct and ... works to improve the organization's efficiency and accuracy related to Medicare Part C/D Grievance and Appeals and to minimize compliance risk exposure to the… more
- UPMC (Pittsburgh, PA)
- …processes as defined the various managed care organizations. Writes letters for provider appeals , member grievances, & DPW requests. Participates in telecons, ... The Care Manager will assist the inpatient treatment teams to ensure... grievance hearings, and DPW pre-hearings/hearings. Reviews and completes MA late… more
- State of Colorado (Sterling, CO)
- CDOC - Corrections Case Manager I (Sterling) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4483465) Apply CDOC - Corrections Case Manager ... is provided, New Hires are typically appointed at the minimum pay for Case Manager I positions of $5,279/month. How To Apply Please submit an online application for… more
- NASCO (Columbus, OH)
- …coordinating efficient and accurate member ad provider servicing as well as Grievance and Appeals processing according to CMS requirements and regulations. + ... service level agreements (SLAs) and metrics are met. The BPS Manager will generate and provide metrics and reporting to demonstrate the performance of the BPS… more
- CVS Health (Frankfort, KY)
- …information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. Coordinates provider status information with member services ... of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards* Excellent… more
- State of Colorado (Denver, CO)
- …activities relative to their performance. The position ensures that mid-level provider on-call practices are responsive to medical; + Providing medical services ... physicals; + Position participates in the monthly "on-call" schedule and may provide on-site assistance to other DOC clinical units and facilities when demonstrated… more
- Ramsey County (St. Paul, MN)
- …County and advise the County Board, Human Resources Department and Labor Relations Manager , and other County clients, on labor and employment law issues by ... and assist in drafting personnel policies and labor agreements, provide legal advice to the Director of Human Resources,...Human Resources, the Human Resource Deputies and Labor Relations Manager , as well as other officials of the County.… more
- State of Colorado (Pueblo, CO)
- …and lower level of care settings can no longer adequately and safely provide effective care. Opt-in below to receive text message updates on CDHS recruiting ... : Direct Support, Mental Health Clinicians, Clinicians, Intensive Case Manager (s), Program Director, Psychiatrist, Nurse Practitioner, Admissions and Coordination,… more
- ERP International (Tinker AFB, OK)
- …* Must be able to collect clinical data from inpatient and outpatient sources, provide documentation for appeals or grievance resolution, apply critical ... Matching 401K!** **About ERP International, LLC:** ERP is a nationally respected provider of health, science, and technology solutions supporting clients in the… more
- Henry Ford Health System (Troy, MI)
- …preferred. + Experience working in Pega Customer Relationship Manager /Appeal and Grievance preferred. + A working knowledge of appeals , grievances, inquiries ... SUMMARY: Responsible for addressing customer inquiries, grievances (complaints), identify appeals , process Individual plan cancellation requests, process deductible transfer… more
- CDS Life Transitions (Webster, NY)
- …in at least one of the following areas: call center operations, MLTC, grievance and appeals , and/or authorizations. The listed salary range represents the ... providing members with exceptional customer service in an inbound call center environment. Provide accurate and efficient member services as part of call center to… more
- Amergis (Fresno, CA)
- …for oversight and management of health policies for a large insurance provider . You'll also be running quality improvement programs and initiatives to ensure ... Management and the Chief Medical Officer, the Medical Management Manager will work closely with their Team and its...and trend audit findings. + Coordinate preparation for the Appeals and Grievances Work Group including draft agenda &… more