- 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: ... safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- Sanford Health (Sioux Falls, SD)
- …governing appeals and grievance resolution. Lead and manage the end-to-end appeals and grievances process for all product lines, ensuring compliance with ... Oversee the intake, review, resolution, and documentation of all appeals , complaints, and grievances to meet regulatory...and documentation of all appeals , complaints, and grievances to meet regulatory and operational standards. Ensure all… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty level … more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a… more
- Molina Healthcare (San Antonio, TX)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
- Point32Health (MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... to organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple requirements/regulations… more
- Molina Healthcare (Bowling Green, KY)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
- Dignity Health (Rancho Cordova, CA)
- …This position is hybrid in-office and work from home.** **Position Summary:** The Appeals and Grievances Coordinator is responsible for supporting the appeals ... with regulatory requirements - facilitating timely and effective resolution of appeals and grievances . Acting a subject matter expert (SME), the Coordinator will… more
- Dignity Health (Rancho Cordova, CA)
- **Job Summary and Responsibilities** The Appeals and Grievances LVN is a critical role responsible for managing and resolving all medical necessity appeal ... and maintaining patient confidentiality (HIPAA) are also essential. Ultimately, the Appeals and Grievances Nurse monitors denial trends, recommends corrective… more
- Healthfirst (FL)
- …outreach through dismissal and complete verbal outreach attempts** + **Analyze incoming appeals and grievances to determine eligibility for dismissal based on ... or GED from an accredited institution + Work experience with appeals and grievances or healthcare environment + Work experience requiring verbal and written… more
- Point32Health (Canton, MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals ...Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and… more
- Modivcare (Ridgeland, MS)
- …opportunity may be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is responsible ... for service failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately provide a… more
- Humana (Richmond, VA)
- …first** Join a team where your expertise truly makes an impact! As a Grievances & Appeals Representative, you'll be a go-to problem solver, turning complex ... to make an impact** **Required Qualifications** + 1+ years of grievances and/or appeals experience. + Data entry experience. + Intermediate proficiency with… more
- Fallon Health (Worcester, MA)
- …other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH ... The Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals & Grievances … more
- Robert Half Accountemps (Eden Prairie, MN)
- …health insurance operations by managing documentation, coordinating with providers, and ensuring appeals and grievances are processed accurately and on time. ... partners to obtain required medical records and supporting documentation. + Process appeals and grievances within established Health Plan timelines (24 hours… more
- Elevance Health (Indianapolis, IN)
- …and forwards to Medical Director for final review and decision. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + ... + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non-clinical… more
- Elevance Health (Tampa, FL)
- …or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + ... + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non clinical… more
- Elevance Health (Columbus, OH)
- …or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + ... + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non clinical… more
- Elevance Health (Mason, OH)
- …providers, and regulatory entities, and serves as a subject matter expert for appeals , grievances , and quality of care issues. .Key responsibilities: serves as ... **Nurse Appeals -Licensed Nurse** **Location** : Ohio, candidates must...and is dependent on court hearing schedules. The Nurse Appeals is responsible for investigating and processing and medical… more
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