- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals (RN)to lead the daily operations ... of our grievance and appeals processes. You will play a crucial role in...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… more
- Centene Corporation (Indianapolis, IN)
- …CANDIDATE MUST RESIDE IN INDIANA **Position Purpose:** Ensure appropriate processing of member grievance appeals , provider appeals , or request for a State ... of contact with the State. Manage the day to day responsibilities of the Grievance & Appeals Coordinators. + Ensure that the Grievance and Appeals … more
- Elevance Health (Richmond, VA)
- **Title: Grievance / Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The ** Grievance / Appeals Analyst I** is an entry level...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Point32Health (MA)
- …members, partners, colleagues and communities. **Job Summary** Under the direction of the A&G Manager , the Appeals & Grievances QA Auditor audits the quality of ... letters and keyed entries from the Grievance and Appeals systems. Checks cases built by other associates to ensure highest level of quality and timeliness.… more
- Corewell Health (Grand Rapids, MI)
- …SITE - Priority Health - 1239 E Beltline - Grand Rapids Department Name PH - Grievance And Appeals Medicare Employment Type Full time Shift Day (United States of ... Federal decisions are properly implemented. Assist the Lead, Supervisor and/or Manager in coordinating activities and in the development/collection of materials… more
- Elevance Health (Walnut Creek, CA)
- **Nurse Appeals - Licensed RN Nurse** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the state of ... locations. **Shift:** Monday to Friday from 8:00am-5:00pm **PST** The **Nurse Appeals ** is responsible for investigating and processing medical necessity appeals… more
- HCA Healthcare (Rochester, NH)
- …set us apart from any other healthcare provider. We are seeking aCase Manager to join our healthcare family. **Benefits** Frisbie Memorial Hospital, offers a total ... - and empowers their passion for patient care. Apply today for our Case Manager opportunity. **Job Summary and Qualifications** The Case Manager is responsible… more
- The Cigna Group (Nashville, TN)
- …related issues, implications and decisions. The Case Management Analyst reports to the Supervisor/ Manager of Appeals and will coordinate and perform all appeal ... **Cigna Medicare Appeals Reviewer:** We will depend on you to...Director. + Determine whether additional pre service, appeal or grievance reviews are required and/or whether additional appeal rights… more
- State of Colorado (Sterling, CO)
- CDOC - Corrections Case Manager I (Sterling) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4826510) Apply CDOC - Corrections Case Manager ... providing opportunities for offenders to receive feedback, crisis intervention, and grievance resolution; + Stresses results oriented direction in guiding offender… more
- CareOregon (Portland, OR)
- Job Title Delegation and Quality Oversight Manager Exemption Status Exempt Department Health Share of Oregon Manager Title Director, Compliance and Quality ... office once a month for meetings. Job Summary The Delegation and Quality Oversight Manager plays a lead role overseeing the work of the Delegation and Quality… more
- Corewell Health (Grand Rapids, MI)
- …experience Extensive knowledge of CMS regulations and process + Previous experience with grievance and appeals processes About Corewell Health As a team member ... Federal decisions are properly implemented. Assist the Lead, Supervisor and/or Manager in coordinating activities and in the development/collection of materials… more
- LA Care Health Plan (Los Angeles, CA)
- …all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters ... collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory… more
- VNS Health (Manhattan, NY)
- …eligibility. + Coordinates with other departments, eg Care Management, Legal Affairs, Grievance and Appeals , Compliance, Membership Eligibility Unit, Quality as ... a Registered Professional Nurse in New York State required + Certified Case Manager preferred Education: + Bachelor's Degree in nursing or equivalent work experience… 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 ... needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its'...data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources. + Achieves and maintains… more
- State of Colorado (Canon City, CO)
- …at the informal level; + Ensures staff compliance with the offender grievance process, offender co-pay, electronic data entry, and information systems requirements; ... establish an eligible list for referral to the hiring manager for final consideration. Be sure the "Work Experience"...Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel… more
- State of Colorado (Denver, CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... establish an eligible list for referral to the hiring manager for final consideration. Be sure the "Work Experience"...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …to medical quality of care and actively participates in the functioning of the plan's grievance and appeals processes. + Along with the nurse supervisor and ... manager identify opportunities for improvement and collaborate to enhance team performance. + Makes appropriate outreach to community and academic based treating… more
- Johns Hopkins University (Baltimore, MD)
- …Hopkins Bayview Medical Center (JHBMC). This position reports to the DOM HR Manager with a reporting relationship to the Associate Administrator for the DOM, ... compensation administration and analysis; benefits administration; employee relations (including grievance resolution, disciplinary action, reductions in force, termination); training… more
- Elevance Health (Columbus, OH)
- …of 2 years related experience preferably in healthcare insurance departments such as Grievance and Appeals , Contracting or Claim Operations, law enforcement; or ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Elevance Health (Los Angeles, CA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more