- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate implementation of the clinical appeal process for ... serves as a resource for associates within the Clinical Appeals and Analysis unit supporting Government Programs lines of...legal proceedings and provide testimony on behalf of the company . + Responsible for development and oversight of the… 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 ... decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and...at 30 days of paid time off and 9 company holidays + Health insurance plan for you and… 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 ... Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare...at 30 days of paid time off and 9 company holidays + Health insurance plan for you and… more
- Elevance Health (Columbus, OH)
- **Manager II Grievance/ Appeals (RN)-California** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 ... locations. **Expected Work Hours:** Monday-Friday; 8am-5pm PST The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and … 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
- R1 RCM (Salt Lake City, UT)
- …financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle ... sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals and Denials Manager** , you will serve as an expert on… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing provider claims appeals , validating ... clinical and medical coding skills to review provider claim appeals for medical necessity, appropriate coding, and pricing of...are allocable to a particular employee remains in the Company 's sole discretion unless and until paid and may… 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 (Harrisburg, PA)
- **SCA Appeals Representative I** **_Locations:_** _This is a virtual position. The ideal candidate must live within 50 miles of one of our NGS_ **_OR_** _Elevance ... for Medicare and Medicaid Services to transform federal health programs. The **SCA Appeals Representative I** position is an entry-level position in the NGS … more
- CVS Health (Hartford, CT)
- …health care more personal, convenient and affordable. **Position Summary** Aetna, a CVS Health Company , a Fortune 6 company , is one of the oldest and largest ... this Medical Director role are related to Regulated Medicare Appeals : * Direct daily work on part C ...This position also includes an award target in the company 's equity award program. In addition to your compensation,… more
- Elevance Health (Palo Alto, 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
- Medical Mutual of Ohio (Brooklyn, OH)
- …appeal/grievance requests and electronic inquiries in order to identify and classify appeals and grievances as outlined in policies and procedures. Using internal ... appropriate area for review. . Facilitates processing of Medicare appeals to the independent review entity (IRE) . Documents...and Compensation: + Employee bonus program. + 401(k) with company match up to 4% and an additional … more
- Centene Corporation (Jefferson City, MO)
- …**Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- State of Indiana (Indianapolis, IN)
- Governor's Summer Intern - DOR Appeals Date Posted: Jan 23, 2025 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
- Elevance Health (Mason, OH)
- **Manager II Grievance/ Appeals (RN)- Claims Support** **Location** : This position will work in a hybrid model (remote and office). Ideal candidates will live within ... locations. Expected Work Hours: Monday-Friday; 8AM-5PM EST The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals… more
- Guardian Life (Bethlehem, PA)
- Guardian is seeking individuals with Group Disability claims experience to join our dynamic Appeals Team. The ** Appeals Case Manager II** (ACM 2) is responsible ... for adjudicating assigned appeals for Group Life and Disability claims. The ACM...inclusive benefits and resources to our colleagues. Explore our company benefits at www.guardianlife.com/careers/corporate/benefits . _Benefits apply to full-time… more
- Centene Corporation (Sacramento, CA)
- …Licensure **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- R1 RCM (Salt Lake City, UT)
- …performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle ... analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse** , you will help review and interpret medical records to… more
- CDPHP (Albany, NY)
- …high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture ... are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities....to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider… more