- UNC Health (Chapel Hill, NC)
- …communities we serve.RN Utilization Manager position specifically for a Utilization Manager/Clinical Appeals Nurse. This person is based at the Hedrick building and ... care transitions & appropriate utilization of services. Coordinates with the support center to assure third party payor pre-certification and/or re-certifications… more
- Army National Guard (Milan, IL)
- …matters and judicial work. The Paralegal Specialist provides legal and administrative support in areas like family law, international law, contract law, defense ... research court decisions and Army regulations, process legal claims and appeals , and prepare records of hearings, investigations, courts-martial, and courts of… more
- CHRISTUS Health (Alamogordo, NM)
- …Medicare Conditions of Participation, DNV standards, HIPAA, and reporting requirements. Submits appeals in a timely manner, upon request by the Director. Initiates ... care plans, including discharge planning, across the continuum of care in support of the GCRMC Mission. Communicates with providers regarding patient status and… more
- Randstad US (Woodland Hills, CA)
- … appeals and grievances + May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, ... grievance and appeals coordinator. + woodland hills , california +...temp to perm + high school + category healthcare support occupations + referenceAB_4530740 job details A trusted client… more
- Centene Corporation (Salem, OR)
- …individual appeals and grievances + May coordinate the Grievance and Appeals Committee + Support the pay-for-performance programs, including data entry, ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- Elevance Health (Rancho Cordova, CA)
- **Manager II Grievance/ Appeals - Claims Support ** **Location: *CA Residential Requirement** This position will work a hybrid model (remote and office). Ideal ... within 50 miles of one of our PulsePoint locations. The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals … more
- CVS Health (Hartford, CT)
- …part C appeals (both provider and member/nonparticipating providers) and Part D appeals .* Provide direct support to appeal nurses and dedicated Medicare part ... after hours and weekend coverage on a rotational basis to support 24/7 appeals work* IRE monitoring and tracking and Utilization Management Strategy … more
- Penn Medicine (Bala Cynwyd, PA)
- …officer on contract negotiations with vendor as needed. + Offers assistance and support on appeals involving Administrative Law Judge + Manage and expedite ... 8:30AM -5:00PM The Director for Hospital Billing Compliance and Government Audits/ Appeals directs the planning, coordinating, scheduling and performance of annual… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …notice. Primary Responsibilities + Effectively manage Appeal Supervisors, providing full-time support to appeals , internal departments, vendors, and customers. + ... About The Role The Appeals Manager is responsible managing Appeal Supervisors and...Customer Service in resolving customer inquiries and concerns. + Support the Client Services department by researching and resolving… more
- Internal Revenue Service (Fresno, CA)
- …Vacancies will be filled in the following specialty areas: Office of Appeals Case and Operations Support Account and Processing Support ... CAREERS? Visit us on the web at www.jobs.irs.gov Responsibilities WHAT IS THE APPEALS DIVISION? A description of the business units can be found at:… more
- Independent Health (Buffalo, NY)
- …Coordinate with external agencies to prepare case files when needed for external appeals . Departmental Support + Assist in meeting department goals and ... and consistent review and investigation of provider and/or member complaints and/or appeals . The Contractual Reviewer-Senior will be required to rely on their… more
- CVS Health (Columbus, OH)
- …contracts, clinical criteria, benefit plan structure, and regulatory requirements to support appeals review.Ensures appeal process compliance with regulatory and ... to implement best in class policies, plans, and procedures in support of the Appeals area objectives.Executes review of all clinical and benefit documentation… more
- Social Security Administration (Washington, DC)
- …executive direction and leadership over the day-to-day activities and operations of the Appeals Council and its support staff. In that capacity, the incumbent ... operational matters, and adjudicative trends at both the administrative appeals level and the court level. The Appeals... appeals level and the court level. The Appeals Council constitutes the adjudicative head of the Agency… more
- State of Massachusetts (Boston, MA)
- …Private Counsel Division, including the Directors of Criminal Trials, Criminal Appeals , Alternative Commitment Support Registration Unit, Parole Advocacy, ... and sex offender registry cases, as well as in appeals and post-conviction and post-judgment proceedings related to those...The Deputy Chief Counsel is responsible for the leadership, support , training and oversight of private bar panels in… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The… more
- Universal Health Services (Richmond, VA)
- …The Atlantic Region CBO is seeking a dynamic and talented Senior Appeals Specialist. The Senior Appeals Specialist is responsible for the ... resolution of all appeals relating to technical issues identified during the billing...subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion… 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, US, ... for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Customer… more
- Universal Health Services (Chicago, IL)
- …appeal activities for the Utilization Management department, including Expedited Appeals , Standard Appeals , External Independent Reviews, Retrospective Reviews, ... and State Fair Hearings. Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested.… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Manager,… more
- College of Western Idaho (Nampa, ID)
- … Development and Writing: * Lead the development and writing of compelling appeals to secure financial support from donors. * Collaborate with fundraising ... * Proven track record of crafting compelling narratives and appeals that drive donor engagement and financial support... appeals that drive donor engagement and financial support * Excellent written and verbal communication skills, with… more
