- Point32Health (FL)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... 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)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is...(Clinical) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals … more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd Street-Full-Time-Days -Remote** The Director, Pre Appeals ... who provides strategic leadership and operational oversight for the hospital's pre- appeals management program. This role ensures the appropriate use of medical… more
- Sanford Health (Sioux Falls, SD)
- …oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, including ACA, ... ensures adherence to all state, federal, CMS, HHS, and quality regulations governing appeals and grievance resolution. Lead and manage the end-to-end appeals and… more
- Elevance Health (Mason, OH)
- **Manager II Grievance/ Appeals -RN** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Hills ( _Must be within commutable distance to one of the listed ... unless an accommodation is granted as required by law._ The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals … more
- Elevance Health (Mason, OH)
- **Nurse Appeals -Licensed Nurse** **Location** : Ohio, candidates must be residents of Ohio to be considered. **Hybrid 1** : This role requires associates to be ... will be necessary and is dependent on court hearing schedules. The Nurse Appeals is responsible for investigating and processing and medical necessity appeals … more
- Oracle (Little Rock, AR)
- …exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering for developing the Claim ... Denial Prevention and Appeals features of Oracle Health Clinical AI Agent (CAA)....necessity, level of care, clinical validation) to lead the appeals initiative to review denied claims, create write-ups for… more
- Centene Corporation (Jefferson City, MO)
- …medical directors and supervise MD's responsible for utilization management and appeals functions to ensure members receive medically necessary, evidence-based care ... the enterprise. + Provide medical leadership for all utilization management ( appeals ), pharmacy, case management, disease management, cost containment, and medical… more
- Point32Health (Canton, MA)
- …(https://www.point32health.org/) . **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
- Molina Healthcare (San Antonio, TX)
- …and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized ... **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, 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 ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to...I primary function is to learn the specialty level appeals and grievances work supporting the higher level position… 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 ... 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
- MTA (Brooklyn, NY)
- Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date...Torts Reports to: Deputy Executive Assistant General Counsel - Appeals Work Location: 130 Livingston St. Brooklyn Hours of… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources....and verbal communications to assist in responses of all appeals based on State and Federal requirements for all… more
- Elevance Health (Cerritos, CA)
- **Title: Grievance/ Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law._ The **Grievance/ Appeals Analyst I** is an entry level position in...an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre… more
- TEKsystems (San Bernardino, CA)
- Description We are seeking a dedicated Clinical Appeals Nurse to join our Revenue Cycle Management team. The ideal candidate will be responsible for managing ... involves reviewing medical records, preparing clinical documentation to support appeals , and following up on submitted appeals ....support appeals , and following up on submitted appeals . The Clinical Appeals Specialist will work… more
- Elevance Health (Indianapolis, IN)
- **Nurse Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... between those hours, including holidays on a rotational basis. The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- TEKsystems (Denver, CO)
- Medical Appeals Specialist (Fully Remote) Make a measurable impact by overturning denials, recovering missed revenue, and improving patient account outcomes. As a ... Medical Appeals Specialist, you'll combine deep payer policy knowledge with...policy knowledge with analytical problem‑solving-owning complex research, writing strategic appeals , and driving high‑stakes follow‑ups to resolution. What you'll… 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 ... that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with...assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit. This position is… more
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