- Elevance Health (Columbus, OH)
- ** Manager II Grievance / Appeals - Claims Support** This position will work in a hybrid model (remote and office). Ideal candidates will live within 50 miles ... of one of our PulsePoint locations. The ** Manager II Grievance / Appeals ** is responsible for management oversight of grievances and appeals departmental… more
- VNS Health (Manhattan, NY)
- …requirements. Also monitors and audits subcontractors who have delegated responsibility for managing grievance and appeals on behalf of the plan to ensure ... collection systems and prepares data reports and analysis of grievance and appeals for program management and...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… more
- Elevance Health (Norfolk, VA)
- …and plan risk, ensures quality, and regulatory compliance.** PRIMARY DUTIES: + Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings. + ... Leads grievance and appeals in regulated audits. +...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Topeka, KS)
- ** Grievance / Appeals Analyst I** **Candidates must be located within 50 miles of Topeka, KS** The ** Grievance / Appeals Analyst I** is an entry level ... position in the Enterprise Grievance & Appeals Department that reviews, analyzes...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… 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
- Elevance Health (Richmond, VA)
- **Title: Grievance / Appeals Analyst II** **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 II** will be responsible for...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Wichita, KS)
- **Member Grievance and Appeals - Business Change Advisor** **Location: Topeka KS, or Olathe, KS** This position will work a hybrid model (remote and office). The ... of our Kansas Elevance Health PulsePoint locations. The **Member Grievance and Appeals - Business Change Advisor** is...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Indianapolis, IN)
- **Title: Grievance / Appeals Representative 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 Representative I** is responsible for reviewing,...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Henry Ford Health System (Troy, MI)
- …necessary internal control oversight information regarding system changes affecting the Appeals & Grievance processing ensuring that proper system testing, ... Appeals and Grievances. + Prepares all appeal and grievance data for regulatory agency reviews (NCQA, CMS, DIFS...maintains and implements an on-going training plan for the appeals and grievance personnel to provide department-wide… more
- Molina Healthcare (New York, NY)
- …7 years experience in healthcare claims review and/or member appeals and grievance processing/resolution, including 2 years in a manager role. * Experience ... Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** **Position Summary:** Reporting to the Director of Appeals & Grievances, the Manager , Appeals & Grievances (A&G) Audit ... Appeals & Grievances Department and delegated entities. The manager will work to ensures complaints and complex issues...+ Develop and execute on strategic opportunities to improve appeals & grievance process to support a… more
- Elevance Health (Olathe, KS)
- **Nurse Appeals ** **Location:** This position will work a hybrid model (remote and office). Candidates must reside in Olathe, KS, Topeka, KS, or Overland Park, KS. ... The **Nurse Appeals ** role is responsible for investigating and processing and...timely to meet regulatory timeframes. + Documents and logs appeal/ grievance information on relevant tracking systems and mainframe systems.… more
- Healthfirst (NY)
- …equivalent work experience + RN or LPN + Experience with utilization management or appeals and grievance processing and compliance + Working experience in a ... for expedited cases + Helps standardize and optimize how Appeals and Grievances are routed + Determine best practices...and DSE on educating providers in how to submit Appeals timely and accurately. + Maintains delegated vendor relationship… more
- CVS Health (Baltimore, MD)
- …providers of new protocols, policies, and procedures + Participates in weekly Grievance and Appeals meetings, tracks and trends provider grievances, monitors ... obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. Coordinates provider status information… more
- Sacramento County (Sacramento, CA)
- Human Resources Manager I Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/3385544) Apply Human Resources Manager I Salary $137,265.12 - ... at 5:00 pm on: 9/20/24, 10/18/24 (final) Positions assigned to Human Resources Manager I, under direction, manage a human resources program that may include… more
- The Cigna Group (Bloomfield, CT)
- …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 Part C Appeals Reviewer: Appeals Processing Analyst** We...Director. + Determine whether additional pre service, appeal or grievance reviews are required and/or whether additional appeal rights… more
- UPMC (Pittsburgh, PA)
- …appeals , member grievances, & DPW requests.Participates in telecons, grievance hearings, and DPW pre-hearings/hearings.Reviews and completes MA late ... The Care Manager will assist the inpatient treatment teams to...creating and updating denial tracking sheets) Participate in telecons, grievance hearings, and DHS pre-hearings/hearings. Assist with the resolution… more
- City and County of San Francisco (San Francisco, CA)
- …leaders to compete for the role of Employee and Labor Relations Director (0932 Manager IV). A leader who can guide wide-ranging labor relations, payroll, leaves, and ... limited to the following: Labor Relations: + Managing negotiations, grievance processes, investigations of employee complaints and concerns, disciplinary hearings… more
- LA Care Health Plan (Los Angeles, CA)
- …following 3 health plan functions: Call Center Operations, Enrollment Services Operations, Appeals & Grievance Operations For Advanced Analytics Lab: Preferred: ... Manager , Business Insights Job Category: Management/Executive Department: Advanced...net required to achieve that purpose. Job Summary The Manager of Business Insights for Advanced Analytics Lab (AAL)… more
- Veterans Benefits Administration (Louisville, KY)
- Summary The Supervisory Veterans Service Representative Assistant Veterans Service Center Manager (AVSCM) shares in the responsibility of managing Veterans Service ... inquiries for approval. Serves as technical advisor to the Service Center Manager and/or Regional Office Director for the administration of Compensation and Pension… more