- 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… more
- VNS Health (Manhattan, NY)
- …requirements. Also monitors and audits subcontractors who have delegated responsibility for managing grievance and appeals on behalf of the plan to ensure ... collection systems and prepares data reports and analysis of grievance and appeals for program management and...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… 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...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Columbus, GA)
- **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...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...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Olathe, 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 ... of our Kansas Elevance Health PulsePoint locations. The **Member Grievance and Appeals - Business Change Advisor** is...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… 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,...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (New York, NY)
- …7 years experience in healthcare claims review and/or member appeals and grievance processing/resolution, including 2 years in a manager role. * Experience ... Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member… 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 (A&G) Audit ... Appeals & Grievances Department and delegated entities. The manager will work to ensures complaints and complex issues...+ Develop and execute on strategic opportunities to improve appeals & grievance process to support a… 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...timely to meet regulatory timeframes. + Documents and logs appeal/ grievance information on relevant tracking systems and mainframe systems.… more
- Healthfirst (NY)
- …equivalent work experience + RN or LPN + Experience with utilization management or appeals and grievance processing and compliance + Working experience in a ... for expedited cases + Helps standardize and optimize how Appeals and Grievances are routed + Determine best practices...and DSE on educating providers in how to submit Appeals timely and accurately. + Maintains delegated vendor relationship… 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
- 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...Director. + Determine whether additional pre service, appeal or grievance reviews are required and/or whether additional appeal rights… more
- UPMC (Pittsburgh, PA)
- …appeals , member grievances, & DPW requests.Participates in telecons, grievance hearings, and DPW pre-hearings/hearings.Reviews and completes MA late ... The Care Manager will assist the inpatient treatment teams to...creating and updating denial tracking sheets) Participate in telecons, grievance hearings, and DHS pre-hearings/hearings. Assist with the resolution… 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 ... providing opportunities for inmates to receive feedback, crisis intervention, and grievance resolution; + Stresses results oriented direction in guiding inmate… more
- CareOregon (Portland, OR)
- …appeals and notify members and providers of outcome. + Assist the Appeals & Grievance Coordinators, Pharmacists, Medical Directors and Quality Improvement ... Pharmacy Benefit Specialist II Exemption Status Non-Exempt Department Pharmacy Manager Title Pharmacy Benefit Operations Supervisor Direct Reports n/a Requisition… more
- City and County of San Francisco (San Francisco, CA)
- …leaders to compete for the role of Employee and Labor Relations Director (0932 Manager IV). A leader who can guide wide-ranging labor relations, payroll, leaves, and ... limited to the following: Labor Relations: + Managing negotiations, grievance processes, investigations of employee complaints and concerns, disciplinary hearings… more
- Elevance Health (Latham, NY)
- …with compliance and legal on audits preferred + Experience with business background in grievance and appeals preferred + Experience with Market Conduct Exams is ... **Program Manager ** **Locations:** The ideal candidate should live within...model (remote and office) 1-2x a week. The **Program Manager ** is responsible for the development and ongoing management… more
- LA Care Health Plan (Los Angeles, CA)
- …following 3 health plan functions: Call Center Operations, Enrollment Services Operations, Appeals & Grievance Operations For Advanced Analytics Lab: Preferred: ... Manager , Business Insights Job Category: Management/Executive Department: Advanced...net required to achieve that purpose. Job Summary The Manager of Business Insights for Advanced Analytics Lab (AAL)… more
- Hackensack Meridian Health (Edison, NJ)
- …to transform healthcare and serve as a leader of positive change. The Manager , Regional Team Member Relations reports to the Dir, TM Relations and participates ... of enhancing our overall TM experience. + Serves as the next step for appeals of dispute resolution matters. Supports and collaborates with the Dir, Labor Relations… more