- 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 (Mason, OH)
- ** Manager II Grievance / Appeals (RN)- Claims Support** **Location** : This position will work in a hybrid model (remote and office). Ideal candidates will ... one of our PulsePoint locations. Expected Work Hours: Monday-Friday; 8AM-5PM EST The ** Manager II Grievance / Appeals ** is responsible for management oversight… 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 ... Elevance Health PulsePoint locations. **Expected Work Hours:** Monday-Friday; 8am-5pm PST The ** Manager II Grievance / Appeals ** is responsible for management… more
- Corewell Health (Grand Rapids, MI)
- …policies which may impact the appeal and review process + Previous experience with grievance and appeals processes. About Corewell Health As a team member at ... SITE - Priority Health - 1231 E Beltline - Grand Rapids Department Name PH - Grievance And Appeals Medicare Employment Type Full time Shift Day (United States of… 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
- 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
- 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
- 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
- CareOregon (Portland, OR)
- Job Title Delegation and Quality Oversight Manager Exemption Status Exempt Department Health Share of Oregon Manager Title Director, Compliance and Quality ... office once a month for meetings. Job Summary The Delegation and Quality Oversight Manager plays a lead role overseeing the work of the Delegation and Quality… 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
- 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
- Henry Ford Health System (Troy, MI)
- …productivity). + Learn and Administer Union contracts, including participating in grievance meetings, timely communication of operational changes with the union. + ... testing. + Comprehensive knowledge of Medicare rules and regulations, including appeals , grievances, the annual election period, Medicare Advantage plans, Part D,… more
- Elevance Health (Los Angeles, CA)
- …and compliance. **How you will make an impact:** + Supporting customer service and grievance & appeals IT execution + Responsible for supporting annual planning, ... preferred + Healthcare experience including customer service, contact center technology and grievance and appeals platforms strongly preferred + Ability to work… 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 (Pueblo, CO)
- …referral information in consultation with the Community Support Team and Placement Manager . + Exchanges information with CMAs and other involved agencies including ... when cases should be escalated to the Community Support Team and Placement Manager . + Coordinates completion of all admission paperwork including consent for various… 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
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …to medical quality of care and actively participates in the functioning of the plan's grievance and appeals processes. + Along with the nurse supervisor and ... manager identify opportunities for improvement and collaborate to enhance team performance. + Makes appropriate outreach to community and academic based treating… more
- Transdev (Dorchester, MA)
- …be called upon to testify on behalf of the Company during the Union grievance process, Accident Review Committee meetings, Safety appeals meetings, and other ... and office assignments at the discretion of the General Manager , Director of Safety and Training, and Safety Desk..., Director of Safety and Training, and Safety Desk Manager . Come join the largest private-sector operator of public… more
- Elevance Health (Costa Mesa, CA)
- …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 (Indianapolis, IN)
- …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
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