- VNS Health (Manhattan, NY)
- …the administration of all BH QM/UM and performance improvement activities, encompassing grievances and appeals , and contributes to various other subcommittees ... leadership and medical director meetings as stipulated by the State BH contract manager . Serves as the principal behavioral health/social care expert and liaison for… 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 ... Oversight is responsible for the oversight of Plan level appeals and grievances within the Appeals... grievances within the Appeals & Grievances Department and delegated entities. The manager … more
- Elevance Health (Columbus, OH)
- ** Manager I - Grievances & Appeals - Provider Disputes** **Location** : This position will work a hybrid model (in office 1-2 days per week). The ideal ... Connecticut, Maine, Missouri, Virginia, Indiana, Kentucky or New York. The ** Manager I - Grievances & Appeals ** is responsible for the management oversight… more
- VNS Health (Manhattan, NY)
- …Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances . + Ensures the accuracy and integrity of data ... OverviewManages the day to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans product lines - Managed Long… more
- Elevance Health (Columbus, GA)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, ... an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Los Angeles, CA)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, ... an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Columbus, OH)
- …50 miles of one of our PulsePoint locations. The ** Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals ... ** Manager II Grievance/ Appeals - Claims Support**...departmental units to investigate, resolve, and respond to client/provider grievances / appeals and ensure compliance with regulatory requirements.… more
- Elevance Health (Bon Air, VA)
- …Department responsible to review, analyze and process pre service and post service grievances and appeals requests related to clinical and non clinical services, ... and analysis of complex pre service and post service grievances and appeals requests from customer and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Richmond, VA)
- …analyzing and processing non-complex and some complex pre service and post service grievances and appeals requests in the Enterprise Grievance & Appeals ... + The analyst may serve as a liaison between grievances & appeals and /or medical management,...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Los Angeles, CA)
- …or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + ... skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Rancho Cordova, CA)
- …or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + ... skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Indianapolis, IN)
- …you will make an impact:** + Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues. + ... of previously processed claims. + Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either… more
- Elevance Health (Topeka, KS)
- …Capabilities and Experiences:** + Experience with Claims, Provider Payments, Provider Grievances , Appeals , administrative hearings, or other legal processes + ... **Provider Grievance and Appeals - Business Change Advisor** **Location: Topeka KS, or...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CareOregon (Portland, OR)
- …customer service, claims processing, prior authorizations, formulary exceptions, appeals , grievances , and project participation. Essential Responsibilities ... formulary exception decisions. + Perform prior authorization reviews with pharmacist oversight. Appeals and Grievances + Explain pharmacy appeal and … more
- State of Colorado (Trinidad, CO)
- CDOC / Corrections Case Manager I (Trinidad) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4658555) Apply CDOC / Corrections Case Manager ... Supervision, Individualized Program Instruction/Tutoring, Multi-Disciplinary Staffing, Responding to Inmate Grievances and Resolving Inmate Issues, Inmate Housing Placement and… 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
- Randstad US (Pleasanton, CA)
- case manager . + pleasanton , california + posted august 20, 2024 **job details** summary + $30 - $31.51 per hour + contract + high school + category computer and ... have a 1 year contract opportunity for a Case Manager in Pleasanton, CA. This position will work from...meet deadlines. Preferred Qualifications: Knowledge of member grievance and appeals process preferred., Knowledge of federal and state laws… more
- State of Colorado (Denver County, CO)
- Manager , Customer Accounts and Variable Data Design - PM I Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4635828) Apply Manager , ... for details on the benefits offered to employees. Description of Job The Manager of Customer Accounts and Variable Data Design reports into the Integrated Document… more
- Washington Metropolitan Area Transit Authority (Washington, DC)
- Contract Manager Job ID: 240287 Location: DC - L'Enfant Plaza Full/Part Time: Full-Time Posting Open-Close 09/10/2024 - 09/24/2024 Union NRP Regular/Temporary: ... the National Contract Management Association (NCMA), the Certified Professional Contracts Manager (CPCM) or an appropriate certificate from a program sponsored by… more
- Point32Health (Canton, MA)
- …action plans; and working collaboratively with other departments such as Appeals and Grievances , Pharmacy, Customer Relations, the Corporate Compliance ... at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Program Manager is responsible for key departmental functions related to the… more
