- Elevait Solutions (Fountain Valley, CA)
- …via phone, email, and written correspondence Educate members on benefits, claims, appeals , grievances, and plan policies Process member grievances, appeals , and ... managed healthcare or health plan environment Knowledge of claims, appeals , grievances, and prior authorizations Bilingual (Spanish/English) preferred Bachelor's… more
- Your Behavioral Health (Torrance, CA)
- …UR team to improve processes and enhance coordination of care Denials & Appeals Support: Assist with denial management, support appeal efforts with case summaries ... and clinical data Help identify trends in authorization delays or denials and provide input to leadership Other Duties: Perform other responsibilities as assigned to support team goals and company needs Qualifications: 1-2 years of utilization review… more
- State of Massachusetts (Boston, MA)
- …IF THE EMBEDDED LINK DOES NOT WORK):* https://careers-publiccounsel.icims.com/jobs/2995/ appeals -attorney pdd- appeals -unit/job The Public Defender Division ... of Massachusetts, is seeking two full-time attorneys for its Appeals Unit in Boston. The Public Defender Division provides...and sex offender registry cases, as well as in appeals and post-conviction and post-judgment proceedings related to those… more
- 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
- CVS Health (Sacramento, CA)
- …Summary** Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals 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 and… 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 (MA)
- …. **Job Summary** SUMMARY Under the general direction of the Member Appeals and Grievance Supervisor the Member 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
- Elevance Health (FL)
- **Nurse Appeals - Litigation & Legal Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, with ... and is dependent on court hearing schedules. The **Nurse Appeals - Litigation & Legal Support** is responsible for...is responsible for investigating and processing and medical necessity appeals requests from members and providers. **How You Will… more
- University of Washington (Seattle, WA)
- …Patient Financial Services Department** has an outstanding opportunity for a **Clinical Appeals and Disputes Nurse.** **WORK SCHEDULE** + 100% FTE + 100% Remote ... + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared to reimburse the UW Medicine for services in accordance with… 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
- Community Health Systems (Franklin, TN)
- **Job Summary** The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely reimbursement. This ... current. + Analyzes denials to determine appropriate actions, completes appeals , or routes cases for clinical appeals as needed. + Files and monitors appeals … more
- Molina Healthcare (Houston, TX)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals … more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, and ... collecting, organizing and tracking information to facilitate and expedite processing of appeals and grievances received from a variety of sources. We are looking… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Insurance Appeals Senior , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the ... auditor to take appropriate action. Prepares necessary documentation for insurance appeals process, ensuring timely follow through. Processes claim adjustments for… more
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