- AlliedTravelCareers (Alturas, CA)
- …13. Resolves personnel concerns at the departmental level, utilizing the grievances process as required.14. Ensures compliance with policies and procedures regarding ... department operations, fire, and safety and infection control. 15. Complies with all organizational policies regarding ethical business practices. Shift: Monday - Friday, 8am - 5pm Specialty Type: Rehabilitation Therapy Sub Specialties: Physical Therapist… more
- Department of Veterans Affairs (San Diego, CA)
- …descriptions and performance standards. Your role will also involve addressing grievances and managing disciplinary actions, making a significant impact on ... healthcare and education. Schedule: Monday through Friday, 8am - 4:30pm excluding Federal Government holidays. This position is not eligible for telework or hybrid work. Qualifications: US Citizenship. Unrestricted US Medical License. Successful completion of… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... candidate selected for this role MUST have recent experience with healthcare/managed care grievances + The candidate selected for this role must live in California… more
- MTA (New York, NY)
- Director, Labor Relations, and Grievances - MTAPD/Security Job ID: 13597 Business Unit: MTA Headquarters Location: New York, NY, United States Regular/Temporary: ... 2025 Description POSTING NO. 13597 JOB TITLE: Director, Labor Relations, and Grievances - MTAPD/Security DEPT/DIV: Employment and Labor Relations WORK LOCATION: 2… more
- Fallon Health (Worcester, MA)
- …regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH Appeals and Grievance ... responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals & Grievances... grievances addressed to the Member Appeals & Grievances Department and Provider Appeals Department. This position will… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... achieve that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a successful and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the...function is to learn the specialty level appeals and grievances work supporting the higher level position in this… more
- Texas Health Resources (Arlington, TX)
- Patient Grievances Program Manager Bring your passion to Texas Health so we are Better + Together Work location: Primarily remote and will office at 612 E Lamar ... the complaints and grievance functions to maximally ensure that identification of grievances is accurate and managed appropriately. Serve as a subject matter expert… more
- Molina Healthcare (Bridgeport, CT)
- …Duties** * Facilitates comprehensive research and resolution of appeals, disputes, grievances , and/or complaints from Molina members, providers, and related outside ... and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes.… more
- Modivcare (Ridgeland, MS)
- …may be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is responsible for establishing ... for service failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately provide a… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider… more
- Dignity Health (Rancho Cordova, CA)
- **Job Summary and Responsibilities** The Appeals and Grievances LVN is a critical role responsible for managing and resolving all medical necessity appeal requests ... patient confidentiality (HIPAA) are also essential. Ultimately, the Appeals and Grievances Nurse monitors denial trends, recommends corrective actions, and provides… more
- Point32Health (MA)
- …coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business. **Job ... organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple requirements/regulations… more
- Point32Health (Canton, MA)
- …coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business. **Job ... Description** + Act as a member advocate; clearly communicating the appeal and grievance process and procedures both orally and in writing. + Manage assigned member appeals and grievance cases from documentation, to investigation, and through resolution,… more
- Humana (Frankfort, KY)
- …+ MD pr DO degree + 2 or more years of project leadership experience + A current and unrestricted license in at least one jurisdiction and willing to obtain license, ... as required, for various states in region of assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid… more
- Commonwealth of Pennsylvania (PA)
- …investigations related to alleged/suspected patient abuse and patient complaints/ grievances . Responsibilities include a strong understanding of regulatory and ... You will gather and analyze data related to patient abuse, patient rights grievances , hospital practices or procedures, and patient care trends. The work of this… more
- Highmark Health (Jefferson Hills, PA)
- …RESPONSIBILITIES** + Effectively triage, investigate, resolve and document complaints and grievances while ensuring adherence to the Patient Bill of Rights, ... regulatory requirements and network policy Patient Complaints, Grievances and Compliments. Analyze complaints and grievances data and report trends and/or… more
- Texas Health Resources (Fort Worth, TX)
- …- using your clinical knowledge to manage patient complaints and grievances * **Work hours:** Full-time, Exempt position, 40 hours/week, Monday-Friday, mainly ... acute care experience Required **What You Will Do** * Receives complaints and/or grievances directly from patients or others on the patient's behalf by multiple… more
- Tufts Medicine (Lowell, MA)
- …Under general supervision, manages, investigates, and responds to patient complaints and grievances for both hospital and clinic patients. Highly visible on all ... patient satisfaction. Works closely with risk management department on sever grievances involving litigation. Assures the organization remains compliant with the CMS… more
- University of Washington (Seattle, WA)
- …compliance with respect to the management of adverse patient events and patient grievances . The Senior Clinical Risk Manager will be the lead for managing risks ... involved in patient care delivery via the successful management of patient grievances involving alleged harm. + Provide proactive clinical risk assessments and… more
