- 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 ... unless an accommodation is granted as required by law._ The ** Manager II Grievance / Appeals ** is responsible for management oversight of grievances and… 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...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Mason, OH)
- …by medical directors and consultants; preparing recommendations to uphold or deny appeals ; and ensuring all grievance processes are completed within regulatory ... and/or 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
- 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 (Tampa, FL)
- **Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... unless an accommodation is granted as required by law._ The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- Elevance Health (Columbus, OH)
- **Nurse Appeals RN** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Fields _(Must be within commutable distance to the listed locations.)_ **Virtual:** ... unless an accommodation is granted as required by law._ The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… 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 ... FH Appeals and Grievances Triage Administrator serves to administer the FH Appeals and Grievance process as outlined in the FH Member Handbook/Evidence of… 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
- CVS Health (Hartford, CT)
- …(PO) is responsible for leading the MHK product development and configuration for the Grievance & Appeals (G&A) Department. This role contributes to the product ... solution. + Ensures requirements are signed by the Value Stream Lead and Product Manager . + Communicate business requirements with DDAT in order for the DDAT team to… more
- Elevance Health (Mason, OH)
- ** Grievance and Appeals Analyst II (Executive Concierge Analyst)** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering ... an accommodation is granted as required by law. The ** Grievance and Appeals Analyst II** is responsible...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CenterWell (Boston, MA)
- …of the role includes an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... member population, or condition type. May also engage in grievance and appeals reviews. May participate on...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… 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
- CVS Health (Trenton, NJ)
- …obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. Coordinates provider status information ... and every day. **Position Summary** + The Medicaid VBS Network State Manager manages and oversees compliance with our Network responsibilities as provided within… 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
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …and Management Team + Legal Department: + Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare Advantage, and InterPlan Program) + ... CPR's Director and Clinical Lead, Operations Lead, Senior Credentialing Manager / Compliance Consultant, Risk Specialist, Exception Review Specialists and Project… more
- Elevance Health (Mason, OH)
- …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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