- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for all lines of business. Responsibilities include, but are not limited to: timely classification and… more
- Commonwealth Care Alliance (Boston, MA)
- …to appeal and grievances. **What You'll Be Doing:** - Processing of Grievances & Appeals . - Responsible for the progress of grievance and appeal intervention and ... pharmacy, dental, reporting, and member services. - Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day tasks and assignments.… more
- VNS Health (Manhattan, NY)
- …issues pertaining to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in defense ... + Enters data and assists with compiling reports and analysis on the grievance and appeals process. For Fair Hearings: + Supports Grievance and Appeals… more
- VNS Health (Manhattan, NY)
- …criteria. + Enters data and assists with compiling reports and analysis on the grievance and appeals process. + Participates in special projects and performs ... experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required +… more
- Robert Half Accountemps (Long Beach, CA)
- Description We are seeking an experienced Medical Grievances and Appeals Specialist to join our dynamic team. The successful candidate will be responsible for ... and regulations. + Provide educational assistance to members regarding the grievance and appeals process. + Ensure record keeping system is maintained and… more
- LA Care Health Plan (Los Angeles, CA)
- …meet and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing ... assisting with the development of a successful and cohesive Appeals and Grievance unit, with a high...and or process improvement. Assist Supervisor to ensure that Specialist provide accurate, timely, and quality responses. Ensure that… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II...is primarily responsible for the overall coordination of the Appeals & Grievance (A&G) program for LA… more
- BayCare Health System (Clearwater, FL)
- …be working remotely? Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist -Health Plan **Location** Clearwater:Park Place | ... to regulatory requirements. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring all necessary… 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, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- UCLA Health (Los Angeles, CA)
- Description As the Appeal & Grievance Specialist , you will be responsible for: + Managing the intake and resolution of member and provider appeals and ... + Working closely with medical director and appeal & grievance team to ensure that all cases are handled...operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred * Experience in interpreting CMS… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... grievance process that meets state, federal, accreditation and other...knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests,… more
- Molina Healthcare (Madison, WI)
- …and problem solving with interdisciplinary teams (IDTs). Maintains and manages an accessible appeals and grievance system for members to utilize. **Essential Job ... **Job Description** **Job Summary** The Specialist , Member Rights serves as a member advocate...and train members of the plan's Local Appeal and Grievance Committee. + Grievance and Appeals… more
- Maryland Department of Transportation (Baltimore City County, MD)
- Labor Relations Specialist (Administrator III) Salary $69,323.00 - $112,044.00 Annually Location Baltimore City Job Type Full Time Job Number ... + Benefits + Questions Description MARYLAND TRANSIT ADMINISTRATION Labor Relations Specialist (Administrator III) (2588) Grade 18 Career Service Open to all… more
- Henry Ford Health System (Grand Blanc, MI)
- …facilities and locations as needed. As a strategic partner, the Labor Relations Specialist provides HR and Labor Relations support to leaders and associates within ... active participation in the negotiations of collective bargaining agreements, manage grievance procedures to handle complaints from unionized employees, and advise… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- HUMAN RESOURCES ANALYST C OR SPECIALIST Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4706651) Apply HUMAN RESOURCES ANALYST C OR ... SPECIALIST Salary $3,570.67 - $6,689.00 Monthly Location Baton Rouge,...or other actions on new and/or updated position descriptions, appeals for reallocation and related transactions. + Submits requested… more
- Kelsey-Seybold Clinic (Houston, TX)
- …determined within appropriate timeframes. This position will serve as a liaison to the Grievance and Appeals Department for Medicare Advantage appeals . The ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews,...to services being rendered for members. The Utilization Review Specialist (LVN) serves as a liaison in reviewing requests… more
- CVS Health (Phoenix, AZ)
- …Maricopa County preferably** **Position Summary** Collaborate with a team specializing in Grievance and Appeals systems. Respond to incoming calls from members, ... - Thoroughly document the member or caller's reason for contacting Grievance and Appeals . - Special projects as needed **Required Qualifications** - 1+ years… more
- New York State Civil Service (Albany, NY)
- …Homeland Security and Emergency Services, Division of Title Human Resources Specialist 3 Labor Relations Occupational Category Other Professional Careers Salary ... agency.*Strong public speaking and presentation skills. Duties Description The Human Resources Specialist 3 Labor Relations (HR Spec 3 LR) will report directly to… more
- Elevance Health (Norfolk, VA)
- …of customer service and manages adjustments, ITS processing, keying, rate negotiation, grievance and appeals , escalations, etc., in providing a seamless Blue ... **Title: Plan to Plan Service Specialist I** **Location:** This position will work a...internal business partners (sales, member experience, claims, medical review, appeals , etc.) and external contacts within the other Blues… more
- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- Summary The Supervisory Program Specialist position is located in the Environmental Management Service at the Jesse Brown VA Medical Center, Chicago, IL . The ... reviews, and mandated education and training, disciplinary actions and responds to appeals and grievances. Attends hearings as requested. This may involve working… more