- Evolent (Columbus, OH)
- …a mission with a company behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part ... of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent… more
- Commonwealth of Pennsylvania (PA)
- Appeals Referee Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4768870) Apply Appeals Referee Salary $75,678.00 - $114,915.00 Annually ... of Labor & Industry is excited to welcome an Appeals Referee to our dedicated team! The primary focus...hear and render decisions in regards to first level appeals , while also serving as a hearing officer for… more
- Martin's Point Health Care (Portland, ME)
- …Plan (USFHP) Appeal Specialists are responsible for processing of all member appeals , non-participating provider pre- and post-service appeals , and participating ... other internal and external partners to ensure a comprehensive appeals management process. Job Description Key Outcomes: + For...Serves as the subject matter expert for Part C appeals Medicare Managed Care Manuals + For USFHP Focused… more
- Point32Health (Canton, MA)
- …are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Appeals and Grievance (A&G) Coordinator is responsible, per State and Federal ... regulations, for assisting with all operational aspects of the Appeals and Grievances assignment process for Point32Health. Responsibilities include, but are not… more
- State of Colorado (Denver, CO)
- Clerk of the Court of Appeals Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4772407) Clerk of the Court of Appeals Salary $10,740.83 - ... of Job Classification: The Clerk of the Court of Appeals is responsible for providing for the administration of...the administration of all aspects of the Court of Appeals . This involves supervising court employees, providing case flow… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for members ... Directs the activities and serves as a resource for associates within the Clinical Appeals and Analysis unit. We are looking for an experienced people leader in the… more
- VNS Health (Manhattan, NY)
- …complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance and appeals ... * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare Advantage (MA), or… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist II will be responsible for the initial analysis of appeals correspondence, and determination of ... organizing and tracking information to facilitate and expedite processing of appeals received from a variety of sources. Responsible for more complicated,… more
- Point32Health (TX)
- …(https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los ... purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting with the...assisting with the development of a successful and cohesive Appeals and Grievance unit, with a high level of… more
- CareFirst (Baltimore, MD)
- …and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an experienced people leader ... with dynamic goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance departmental capabilities. Accountable… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- Elevance Health (Atlanta, GA)
- …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...and regulatory compliance.** PRIMARY DUTIES: + Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings. + Leads… more
- Grand Canyon University (Phoenix, AZ)
- Academic Compliance -University Appeals Administrator job in Phoenix, AZ with Grand Canyon University + Search All Jobs + Careers Home + Faculty Jobs + Staff Jobs + ... Opportunities + Return to GCU Home (https://www.gcu.edu/) Academic Compliance -University Appeals Administrator Click Here to Apply Online Job Description Grand… 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 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- Catholic Health Services (Melville, NY)
- …Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals according ... and/or escalates denial when appropriate. | Submits all (initial and/or appeals ) reviews and/or letters within contractual or regulatory timeframes. | Collaborates… more
- Elevance Health (Costa Mesa, CA)
- **Nurse Appeals - Licensed RN Nurse** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the state of ... locations. **Shift:** Monday to Friday from 8:00am-5:00pm PST The **Nurse Appeals ** is responsible for investigating and processing medical necessity appeals… more
- State of Indiana (Indianapolis, IN)
- Governor's Summer Intern - DOR Appeals Date Posted: Dec 25, 2024 Requisition ID: 452851 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling ... its commitment to employee engagement and satisfaction. About the DOR Appeals Team: The DOR Appeals team serves as an impartial arbiter of various protestable… more
- City of New York (New York, NY)
- …Department is seeking applicants for an Assistant Corporation Counsel position in its Appeals Division. The Appeals Division handles appeals originating from ... before federal and state appellate courts and are responsible for briefing and arguing appeals in an array of cases, from routine litigation arising out of the… more
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