- Apex Health Solutions (Houston, TX)
- Summary: The Appeals and Grievances coordinator, Senior position, is focused on the processing of customer and provider Medicare and Commercial appeals ... and grievances . This associate may screen incoming complaints, process medical necessity, utilization management and claims appeals , initiate Independent… more
- Health First (Melbourne, FL)
- …to resolve internal operational issues that may cause increase to member appeals / grievances volumes and drive operational efficiencies. 10. Maintain technical ... Insurance)* **Organization:** **HF Administrative Plan Inc* **Title:** *Manager Complaints, Grievances , and Appeals * **Location:** *Florida - Brevard… more
- Health First (Rockledge, FL)
- …Plan Inc* **Title:** *HFHP Appeal /Grievance Coordinator - Member Appeals Grievances * **Location:** *Florida - Brevard County-Rockledge* **Requisition ... and timeframes with them. * Correctly identifying and interpreting medical , contractual or legal issues related to complaints and...to the public. *Stewardship: * * Elevating issues to senior management as necessary to minimize financial risks. *… more
- Geisinger (Danville, PA)
- …and benefit issues and concerns regarding quality of care or service. PresentsMember appeals to the Plan Medical Staff and Center for Medicare/Medicaid Services ... contracted reviewer. Job Duties + Prepares and facilitates Member appeals , complaints and grievances by communicating directly with Members, their… more
- Medical Mutual of Ohio (OH)
- …new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances , and Medicare marketing material requirements. . Assists ... new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances , and Medicare marketing material requirements. . Assists… more
- Sharp HealthCare (San Diego, CA)
- …for the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for ... to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify… 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, ... invite you to learn more and apply today! The Senior Medical Director provides guidance for clinical...with the Counties and DHS + Reviews complaints and grievances in accordance with Community Care procedures and ensures… more
- Highmark Health (Pittsburgh, PA)
- …for members, improving payment integrity, and optimizing the experience of denials, appeals , and grievances . The ideal candidate outlines the strategic vision ... **.** This includes a strong grasp of claims intake, adjudication, payment, appeals , denials, and grievances along with familiarity with various claim… more
- City and County of San Francisco (San Francisco, CA)
- …City and County of San Francisco is looking to bring on board multiple Senior Human Resources Analysts to help departments in hiring, supporting, and retaining a ... growth, the City offers excellent benefits that include: competitive salaries; medical , dental, and vision insurance; defined benefit retirement plan; deferred… more
- Point32Health (Canton, MA)
- …met + Track stakeholder feedback on product performance throughout the year, including Appeals & Grievances to help inform future benefit design guidance, ... are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Senior Manager of Product Implementation and Administration will have two main… more
- Centene Corporation (Atlanta, GA)
- …management programs, integrate physician services, quality assurance, appeals and grievances , and regulatory compliance programs with medical service and ... with regulatory agencies. + Supports the Health Plan Chief Medical Officer or Senior Medical ...resolution of member or provider grievances and appeals + Optimizes utilization of medical resources… more
- VNS Health (Manhattan, NY)
- …clinical expertise and guidance to the daily operations and administration of medical management for VNS Health Plans. Assists senior leadership in ... coordinating all medical and related activities. Participates in implementing standards of medical service and advises senior leadership on medical and… more
- Sharp HealthCare (San Diego, CA)
- …+ Performs Medical Necessity Reviews including utilization management and appeals and grievances . Assists physician team in researching and writing ... Will Do** The position is responsible for the performing medical utilization reviews and appeals and grievance... and grievance reviews under the direction of the Senior Medical Director or designee for Sharp… more
- AvantGarde, LLC (Washington, DC)
- …implementing regulations and applicable labor contract provisions. + Responding to grievances , unfair labor practice complaints, disciplinary decision appeals , ... AvantGarde, LLC (AG) seeks to engage a Senior Human Resources Specialist (Labor Relations) who supports...monthly commuter benefit as well as immediate 401k and medical enrollment. This is a Full-time position, 40 hours… more
- AdventHealth (Maitland, FL)
- …developing specific strategies and criteria addressing areas of need.Collaborates with Senior Medical Officers with contracted managed care payers regarding ... makes recommendations on appealed provider claims and makes determinations for appeals & grievances from members.Provides support, shares administrative call,… more
- SUNY Upstate Medical University (Syracuse, NY)
- About The State University of New York and SUNY Upstate Medical University: The State University of New York is the largest comprehensive system of higher education ... one of SUNY's 64 colleges and universities. SUNY Upstate Medical University, located in Syracuse NY, is 1 of...Office of General Counsel: Under the leadership of the Senior Vice Chancellor for Legal Affairs and General Counsel,… more
- Volunteers of America Los Angeles (Los Angeles, CA)
- …and resolution of facts and issues in matters affecting disciplinary actions, grievances , appeals , and complaints, refers complex matters to HR Employee ... PAY RATE:$80116.92 - $84333.60 Per Year BENEFITS:VOALA offers competitive medical , dental, vision and retirement benefits. JOB SUMMARY AND...Relations Specialist or Senior Manager of Employee Relations as required + Participates… more
- Fallon Health (Worcester, MA)
- …**Brief Summary of Purpose:** With general direction from the Vice President and Senior Medical Director of Quality and Population Health, the Director of ... as quality improvement, credentialing, member rights, utilization management, including member appeals and grievances to support them in accreditation… more
- Sacramento County (Sacramento, CA)
- …recruitment includes, but is not limited to, the following position: Senior and Adult Services Human Services Division Manager. Click here ... flexible spending account options for dependent care and unreimbursed dental and/or medical cost; and an employee assistance program (EAP). GENERAL BENEFITS: Most… more
- Sacramento County (Sacramento, CA)
- …flexible spending account options for dependent care and unreimbursed dental and/or medical cost; and an employee assistance program (EAP). GENERAL BENEFITS: Most ... a pre-tax basis via payroll deduction, to pay for medical , dental or dependent care expenses. + DEPENDENT CARE...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more