- VNS Health (Manhattan, NY)
- …navigating the 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 processes. You will play a crucial role in...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… more
- Elevance Health (Walnut Creek, CA)
- ** Manager II Grievance / Appeals (RN)-California** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live ... Hills** + **Costa Mesa** + **Palo Alto** + **Walnut Creek** The ** Manager II Grievance / Appeals ** is responsible for management oversight of grievances and … more
- Elevance Health (Mason, OH)
- …and plan risk, ensures quality, and regulatory compliance.** PRIMARY DUTIES: + Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings. + ... Leads grievance and appeals in regulated audits. +...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CareFirst (Baltimore, MD)
- …membership, and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an experienced people ... field, Legal Nurse Consultant, Utilization Management, and Government Program experience with Appeals and Grievance , Experience with MCG, InterQual, NCD and… more
- Apex Health Solutions (Houston, TX)
- …cost efficiency and a commitment to the Continuous Quality Improvement Process. The Appeals & Grievance Coordinator, Senior, will interact on a daily basis ... Summary: The Appeals and Grievances coordinator, Senior position, is focused...decisions with appropriate, understandable correspondence Work directly with the Manager to meet the department's needs Serve as a… more
- CareFirst (Baltimore, MD)
- …educational and training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in the development and ... 3 years supervisory experience Utilization Management, and Government Program experience with Appeals and Grievance , Experience with MCG, InterQual, NCD and… more
- Conduent (Hamilton, NJ)
- …and Health Services (DMAHS) of New Jersey. **Reports To** This position reports to the Appeals Supervisor and the Appeals Manager . The Appeals ... individuality is noticed and valued every day. Fair Hearing Appeals Agent $18.50/ Hourly Onsite- Hamilton, NJ Full-time and...assistance for medical services may appeal Fair Hearing or Grievance decisions to which they were denied coverage, or… more
- Elevance Health (Los Angeles, 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
- CareFirst (Baltimore, MD)
- …organization or hospital preferred. + BSN/MSN Degree. Government Program experience with Appeals and Grievance , Experience with MCG, InterQual, NCD and LCD's. ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation...Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred + LNCC - Legal Nurse… more
- Maryland Department of Transportation (Anne Arundel County, MD)
- …as the delegated representative of the Secretary of Transportation for Second Step grievance appeals and disciplinary action appeals . + Negotiating the ... Labor Relations Manager (DOT Executive IV) Salary $95,991.00 - $154,928.00 Annually Location Anne Arundel County Job Type Full Time Remote Employment… more
- State of Colorado (CO)
- …grammar, spelling, punctuation and formatting; + Provide initial guidance/review of Grievance and 1450-05 complaint responses; assist with grievance panels; ... policy, State Personnel Board Rules, legal precedence, and DOC performance standards. Appeals & Legal Case- Requests for Information + Exercise discretion and… more
- Sacramento County (Sacramento, CA)
- Human Services Division Manager Range A/B Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/2234944) Apply Human Services Division Manager ... $12,042.50 - $14,636.88/month Under executive direction, the Human Services Division Manager plans, coordinates and administers a human services division comprised… more
- Sacramento County (Sacramento, CA)
- Human Services Program Manager Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/2751183) Apply Human Services Program Manager Salary ... 12/4/2024, 12/18/2024 (Final) Under direction, the Human Services Program Manager plans, coordinates and manages the work of a...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more
- Hackensack Meridian Health (Edison, NJ)
- …to transform healthcare and serve as a leader of positive change. The Manager , Regional Team Member Relations reports to the Dir, TM Relations and participates ... of enhancing our overall TM experience. + Serves as the next step for appeals of dispute resolution matters. Supports and collaborates with the Dir, Labor Relations… more
- VNS Health (Manhattan, NY)
- …eligibility. + Coordinates with other departments, eg Care Management, Legal Affairs, Grievance and Appeals , Compliance, Membership Eligibility Unit, Quality as ... a Registered Professional Nurse in New York State required + Certified Case Manager preferred Education: + Bachelor's Degree in nursing or equivalent work experience… more
- City and County of San Francisco (San Francisco, CA)
- …ensuring adherence to relevant City laws and regulations, including the Shelter Grievance Ordinance, and managing the shelter placement process. + Oversees the ... on the Eligible List. A passing score on the Manager Test Battery and Training and Experience Evaluation questionnaire...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- Elevance Health (Columbus, OH)
- …looking to hire an Execution Director. Reporting directly to the VP of Grievance & Appeals , this high-performing individual contributor Director will use their ... with health plan operations and back office, Medicare, Medicaid, Grievances & Appeals (G&A), Enrollment, and Billing. + Demonstrated experience with designing and… more
- Sharp HealthCare (San Diego, CA)
- …to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager to identify ... needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its'...data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources. + Achieves and maintains… more
- State of Colorado (Denver, 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
- Johns Hopkins University (Baltimore, MD)
- …Hopkins Bayview Medical Center (JHBMC). This position reports to the DOM HR Manager with a reporting relationship to the Associate Administrator for the DOM, ... compensation administration and analysis; benefits administration; employee relations (including grievance resolution, disciplinary action, reductions in force, termination); training… more
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