- Elevance Health (Bon Air, 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
- Henry Ford Health System (Troy, MI)
- …and thorough investigation of medical , transportation, and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare ... AND RESPONSIBILITIES:\ + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center for… 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
- 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
- Sacramento County (Sacramento, CA)
- Senior Contract Services Officer Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/3577509) Apply Senior Contract Services Officer Salary ... cut-offs are at 5:00 pm on: 7/5/24, 8/2/24, 8/30/24, 9/27/24 (final) Senior Contract Services Officer performs leadwork and/or advanced journey level, analytical… 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
- Elevance Health (Indianapolis, IN)
- …certification will be considered.** **The Strategy Director** supports Government Business Grievances & Appeals and Government Business Enrollment Billing. In ... metrics to track budget and spending. + Collaborates with senior team and staff to develop tactical plans and...+ Business knowledge in Government Health Benefits to include Grievances & Appeals and/or Enrollment Billing preferred.… more
- Sacramento County (Sacramento, CA)
- …court decisions including Civil Rights Act, Americans with Disabilities Act, Family Medical Leave Act, California Family Rights Act, Pregnancy Disability leave, Fair ... Free Workplace Act + Principles and methods for investigating and resolving grievances and complaints + Principles and practices of organizational behavior and… more
- AdventHealth (Maitland, FL)
- …developing specific strategies and criteria addressing areas of need.Collaborates with Senior Medical Officers with contracted managed care payers regarding ... makes recommendations on appealed provider claims and makes determinations for appeals & grievances from members.Provides support, shares administrative call,… 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
- Point32Health (Canton, MA)
- …action plans; and working collaboratively with other departments such as Appeals and Grievances , Pharmacy, Customer Relations, the Corporate Compliance ... process improvement activities. Report actual and potential risks for non-compliance to senior manager and lead mitigation planning activities. Provide guidance to … more
- VNS Health (Manhattan, NY)
- …the administration of all BH QM/UM and performance improvement activities, encompassing grievances and appeals , and contributes to various other subcommittees ... company holidays + Health insurance plan for you and your loved ones, Medical , Dental, Vision, Life and Disability + Employer-matched retirement saving funds +… more
- Veterans Benefits Administration (Newark, NJ)
- …relations issues. Advise on actions concerning employee management communications, grievances and appeals , disciplinary actions and performance. Research ... the Department of Veterans Affairs, VA Regional Office, reporting to Regional Office Senior Leadership in the locations listed above. The incumbent serves as a… more
- LA Care Health Plan (Los Angeles, CA)
- …care setting. Experience in health care auditing and monitoring (preferably in Appeals , Grievances , Quality Improvement, Utilization Management (UM) and so ... Care's risk to state/federal sanctions and fines- communicate required action to senior management/Board of Governor (BoG), Plan Partner staff. 2. Internal audit… more
- Fallon Health (Worcester, MA)
- …as quality improvement, credentialing, member rights, utilization management, including member appeals and grievances to support them in accreditation ... Centers of Medicare and Medicaid, the Massachusetts Division of Medical Assistance, and the Division of Insurance. This position...regulatory environment to promote awareness with other directors and senior leaders of the health plan the impact of… more
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