- 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 ... net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General...and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best… more
- Elevance Health (FL)
- …by medical directors and consultants; preparing recommendations to uphold or deny appeals ; and ensuring all grievance processes are completed within regulatory ... paralegal experience is strongly desired. + Understanding of the grievance and appeals process is strongly preferred....Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Union, NE)
- **SCA Appeals Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... Medicare and Medicaid Services to transform federal health programs. The **SCA Appeals Rep I** is Responsible for reviewing, analyzing, and processing non-complex… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... and Grievances Triage Administrator serves to administer the FH Appeals and Grievance process as outlined in...calendar or at the direction of a supervisor or manager . **Qualifications** **Education** High School Diploma or GED required.… more
- Transdev (Dorchester, MA)
- Overview: Transdev in Boston, MA is seeking a Labor Relations Manager for its Boston Public Schools transportation contract. The Labor Relations Manager provides ... Responsibilities: + Manage labor relations program of the property jointly with the General Manager . + Research, compile, and prepare data for use in grievance … more
- CVS Health (Annapolis, MD)
- … partners cross-functionally with Provider Relations, Configuration, Compliance, Finance, Appeals and Grievance . and Medical Management. **Key Responsibilities** ... do it all with heart, each and every day. **Position Summary** The Manager of Claims Management is responsible for overseeing Medicaid claims operations, inventory… more
- LA Care Health Plan (Los Angeles, CA)
- …all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters ... collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory… more
- State of Colorado (Brighton, CO)
- …and respond to youth grievances in accordance with DYS Policy 13.2 Grievance Procedures. Responsible for logging grievances on the tracking form and submitting ... relevant to youth rights. + Collaborate with the Youth Center PREA Compliance Manager to gather information and data for internal investigations. + Serve as the… more
- Elevance Health (Miami, FL)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations....Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- State of Colorado (CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... establish an eligible list for referral to the hiring manager for final consideration. Be sure the "Work Experience"...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …referrals generated to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department ... functions assigned to non-care managers are monitored by the care manager + The care manager provides feedback to the non-care manager 's supervisor, as… more
- Elevance Health (Miami, FL)
- …of 2 years related experience preferably in healthcare insurance departments such as Grievance and Appeals , Contracting or Claim Operations, law enforcement; or ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Elevance Health (Woodbridge, NJ)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Elevance Health (New York, NY)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …procedures, including review of documentation such as I-9 forms, grievance reports, workers' compensation claims, and pre-existing condition disclosures. The ... the Office of Risk Management liaison - Human Resources Manager . * Develop and maintain the House Human Resources...* Represent the House in depositions, hearings, trials, and appeals when necessary. * Provide proactive legal guidance to… more
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