- Providence (Anaheim, CA)
- **Description** The Senior Manager Appeals and Grievances has direct responsibility for the design, implementation and ongoing operations of the Health Plan ... and ensures the efficient operational management of health plan appeals and grievances with emphasis on patient...Senior Manager will work closely with each network Medical Director in using clinical knowledge, experience and licensures… more
- Point32Health (MA)
- …click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Senior Manager of Appeals and Grievances the Appeals ... and provide leadership for the daily operations of the Appeals and Grievances department. The Supervisor represents...assigned team of Analysts and Coordinators + Work with Senior Manager to ensure that employees have the requisite… more
- Health First (Rockledge, FL)
- …Plans (Health Insurance)* **Organization:** **HF Administrative Plan Inc* **Title:** *HFHP Appeals /Grievance Coordinator - Member Appeals Grievances * ... and timeframes with them. * Correctly identifying and interpreting medical , contractual or legal issues related to complaints and...to the public. *Stewardship: * * Elevating issues to senior management as necessary to minimize financial risks. *… more
- Elevance Health (KS)
- …Elevance Health PulsePoint locations. The **Grievance and Appeals Program Manager, Senior ** will be responsible for managing Provider Grievances , Provider ... **Grievance and Appeals Program Manager, Senior ** **Location:** Kansas....of process redesign strongly preferred. + Experience with Member Grievances , Appeals , administrative hearings, or other legal… more
- The Cigna Group (Bloomfield, CT)
- …not limited to:** + Ability to differentiate different types of requests Appeals , Grievances , coverage determination and Organization Determinations in order to ... documents, correct appeal types, timeframes and what is being appeals + Assign priority and internal due date based...Minimum High School Diploma Required. Prefer background as a medical assistant or prior Medicare Claims experience + 2+… more
- Elevance Health (Richmond, VA)
- …+ HS diploma or equivalent + Minimum of 3 years of Grievance & Appeals Senior analyst experience; or any combination of education and experience which ... review, analyze and process pre service and post service grievances and appeals requests related to clinical...the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route… more
- Elevance Health (Norfolk, VA)
- …school diploma or GED equivalent and a minimum of 3 years of Grievance & Appeals Senior analyst experience; or any combination of education and experience which ... review, analyze and process pre service and post service grievances and appeals requests related to clinical...the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route… more
- Medical Mutual of Ohio (OH)
- …new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances , and Medicare marketing material requirements. . Assists ... new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances , and Medicare marketing material requirements. . Assists… more
- Sharp HealthCare (San Diego, CA)
- …for the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for ... to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify… more
- UPMC (Moosic, PA)
- We have an exciting opportunity for a full-time Senior Medical Director to join our leadership team with UPMC Community Care! As Senior Medical Director, ... invite you to learn more and apply today! The Senior Medical Director provides guidance for clinical...with the Counties and DHS + Reviews complaints and grievances in accordance with Community Care procedures and ensures… more
- Highmark Health (Pittsburgh, PA)
- …for members, improving payment integrity, and optimizing the experience of denials, appeals , and grievances . The ideal candidate outlines the strategic vision ... **.** This includes a strong grasp of claims intake, adjudication, payment, appeals , denials, and grievances along with familiarity with various claim… more
- City and County of San Francisco (San Francisco, CA)
- …City and County of San Francisco is looking to bring on board multiple Senior Human Resources Analysts to help departments in hiring, supporting, and retaining a ... growth, the City offers excellent benefits that include: competitive salaries; medical , dental, and vision insurance; defined benefit retirement plan; deferred… more
- CVS Health (Baton Rouge, LA)
- …and provider education. + Participates, when requested, in Grievance and Appeals meetings, and/or assists with tracking and trending provider grievances ... required information from Providers, such as HEDIS, Credentialing. Grievance and Appeals , SIU, etc. Coordinates provider status information with member services and… more
- TAD PGS, Inc. (Chicago, IL)
- …matters such as the implementation of policy and initiatives within the parameters, grievances , arbitrations , the Family and Medical Leave Act, Affordable Care ... matters . + Oversees matters related to the Employee Appeals Board and acts as representative of the Employee... Board and acts as representative of the Employee Appeals Board. + Counsels various departments and offices in… more
- Sharp HealthCare (San Diego, CA)
- …+ Performs Medical Necessity Reviews including utilization management and appeals and grievances . Assists physician team in researching and writing ... Will Do** The position is responsible for the performing medical utilization reviews and appeals and grievance... and grievance reviews under the direction of the Senior Medical Director or designee for Sharp… more
- State of Colorado (Grand Junction, CO)
- …designation activities on behalf of the BHA and receives and investigates grievances submitted to the BHA through complaints and critical incident reporting. Summary ... residential, intensive outpatient, partial hospitalization and outpatient services. As Senior Authority, this position is responsible for developing policy that… more
- AvantGarde, LLC (Washington, DC)
- …implementing regulations and applicable labor contract provisions. + Responding to grievances , unfair labor practice complaints, disciplinary decision appeals , ... AvantGarde, LLC (AG) seeks to engage a Senior Human Resources Specialist (Labor Relations) who supports...monthly commuter benefit as well as immediate 401k and medical enrollment. This is a Full-time position, 40 hours… more
- UCLA Health (Los Angeles, CA)
- …utilization and case management activities to drive efficiency and quality + Oversee appeals , grievances , and potential quality issues (PQI) + Develop and ... at New Century Health Plan. Reporting to the Chief Medical Officer, you will play a pivotal role in...and ensure compliance with regulatory requirements + Collaborate with senior leaders to enhance the overall performance of the… more
- SUNY Upstate Medical University (Syracuse, NY)
- About The State University of New York and SUNY Upstate Medical University: The State University of New York is the largest comprehensive system of higher education ... one of SUNY's 64 colleges and universities. SUNY Upstate Medical University, located in Syracuse NY, is 1 of...Office of General Counsel: Under the leadership of the Senior Vice Chancellor for Legal Affairs and General Counsel,… more
- Fallon Health (Worcester, MA)
- …**Brief Summary of Purpose:** With general direction from the Vice President and Senior Medical Director of Quality and Population Health, the Director of ... as quality improvement, credentialing, member rights, utilization management, including member appeals and grievances to support them in accreditation… more
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