- 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 (Sacramento, CA)
- …initial and ongoing training in necessary skills and knowledge base and will assist Manager of Grievance and Appeals to establish and maintain procedures ... **Remote-CA. Must reside in California **Healthcare lead experience with claims, appeals , and grievance strongly preferred.** **Position Purpose:** The… more
- UCLA Health (Los Angeles, CA)
- Description The Appeals & Grievance Intake Coordinator serves as the primary point of contact for receipt of member-initiated complaints and Health Plan ... grievances and appeals . The Grievance and Appeals ...regulations with direction from the Medical Director and QM Manager . + Review all member appeals and… 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
- Point32Health (MA)
- …direction of the Senior Manager of Appeals and Grievances the Appeals and Grievance Supervisor, through the use of general knowledge of Plan benefits ... and provide leadership for the daily operations of the Appeals and Grievances department. The Supervisor represents the ...team of Analysts and Coordinators + Work with Senior Manager to ensure that employees have the requisite information… 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
- State of Colorado (Denver, CO)
- CDOC Corrections Case Manager I (Denver) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4849012) Apply CDOC Corrections Case Manager I ... offender re-entry into society. Primary job duties and responsibilities for Case Manager positions include, but are not limited to: + Meets with individual… 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
- Sacramento County (Sacramento, CA)
- Human Services Division Manager Range A/B Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/2234944) Apply Human Services Division Manager ... $12,042.50 - $14,636.88/month Under executive direction, the Human Services Division Manager plans, coordinates and administers a human services division comprised… 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
- 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 (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
- Elevance Health (Chicago, IL)
- …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
- MyFlorida (Tampa, FL)
- …of incident reporting, fatality reviews and continuous quality improvement reports, grievance / appeals and use this information initiate regional improvements. ... substance use disorder programs as assigned by the Regional Licensing Manager in accordance with established guidelines. Identify any corrective actions plans… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …and brings employee relations matters to final resolution. Manage the staff appeals processes. * Partner with the Office of General Counsel, Institutional ... as needed. * Advise/refer faculty and staff on appropriate grievance procedures; advise managers/supervisors on required corrective action procedures; review,… more
- Somatus (Mclean, VA)
- …+ Oversee new client pre-delegation audits, annual client audits, development of grievance and appeals workflow processes, and other regulatory requirements. + ... Special Need Plans (SNPs). The Director, Quality will work closely with Sr. Manager , Audit Risk and the Regulatory and Accreditation Team to ensure compliance with… more
- LA Care Health Plan (Los Angeles, CA)
- …collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory ... inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance /appeal requests, and prepares UM Activity and Weekly Compliance… more