- 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 ... Oversight is responsible for the oversight of Plan level appeals and grievances within the Appeals &...Appeals & Grievances Department and delegated entities. The manager will work to ensures complaints and complex issues… more
- 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 units to… more
- Kepro (Harrisburg, PA)
- …a vital partner for health solutions in the public sector. Acentra is looking for a Appeals Manager to join our growing team. Job Summary: The purpose of this ... performance standards. This role will oversee the Mediation and Appeals Team who manage a caseload of assigned cases...and the Mediation Tracker within prescribed timelines. The Clinical Manager coordinates with the Directors and Program Leads on… more
- VNS Health (Manhattan, NY)
- …to, Provider Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances. + Ensures ... to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans...subcontractors who have delegated responsibility for managing grievance and appeals on behalf of the plan to ensure operational… more
- RWJBarnabas Health (Oceanport, NJ)
- Manager , AppealsReq #:0000169981 Category:Leadership Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate Services Department: Appeals Location: ... is an integral part of our company's success The Manager of theAppeals teamwithin the RWJ Barnabas healthcare facilities...a plus either in Utilization Review, Case Management or Appeals + Focused denials and appeals management… more
- Elevance Health (Norfolk, VA)
- …Elevance Health location. **Responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to grievances and ... appeals , manages inventory and production levels, and operational and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… 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 will depend on you to communicate some of our most critical information to the correct… more
- Children's Home Healthcare (Richardson, TX)
- …(This is not a remote position) Billing Assistant Essential Functions: + Assist Billing Manager and Appeals Manager with billing operations of agency on ... no claims are filed outside to the timely filing deadlines. + Assist appeals manager with daily appeals and appeal projects. Billing Assistant Financial and… more
- Mount Sinai Health System (New York, NY)
- …to Case Managers and other hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management, Managed Care Contracting, and other ... **Job Description** **The Nursing Clinical Manager (NCM) for Case Management - Mount Sinai...Case Management - Mount Sinai Hospital** The Nursing Clinical Manager (NCM) for Case Management is responsible for the… more
- Mount Sinai Health System (New York, NY)
- …to Case Managers and other hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management, Managed Care Contracting and other ... **Job Description** The Nursing Clinical Manager (NCM) for Case Management is responsible for...performance evaluation, performance improvement, and staff education. The NCM Manager serves as a resource/mentor for Case Managers, Social… more
- Molina Healthcare (New York, NY)
- …for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and ... * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing... and grievance processing/resolution, including 2 years in a manager role. * Experience reviewing all types of medical… 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 and processes non-complex pre...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 position in...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 reviewing, analyzing...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… 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...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible...culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the A&G Leadership in… 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, analyzing and...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 ... our Kansas Elevance Health PulsePoint locations. The **Member Grievance and Appeals - Business Change Advisor** is responsible for representing the Member Grievance… more
- Elevance Health (Columbus, OH)
- **Audit & Reimbursement Senior- Appeals ** _This is a United States based, virtual position._ **National Government Services** is a proud member of Elevance Health's ... Services to transform federal health programs. The **Audit and Reimbursement Senior- Appeals ** will support our Medicare Administrative Contract (MAC) with the… more