- VNS Health (Manhattan, NY)
- …the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance ... timely processing for the Medicare and Medicaid appeal and grievance processes, incidents, quality of care concerns and any...are educated and compliant with requirements of appeals and grievance regulations and processing. + Work closely with all… more
- CVS Health (Tallahassee, FL)
- …units. Ensure timely, customer focused response to appeals, complaints and grievance . Identify trends and emerging issues and report and recommend solutions. ... -Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit based upon...work items that do not meet appeals, complaints and grievance criteria. -Research Standard Plan Design or Certification of… more
- City of New York (New York, NY)
- …to provide administrative support to the Executive Director of Constituent and Grievance Services. The Office of Constituent and Grievance Services (OCGS) ... goals. Under executive direction of the Executive Director of Constituent and Grievance Services, the incumbent will be responsible for the following duties: -… more
- Commonwealth Care Alliance (Boston, MA)
- …Processing of Grievances & Appeals: * Responsible for the progress of grievance and appeal intervention and resolution. * Assure verbal and written responses ... verbal and written correspondence. * Thoroughly document all member appeal and grievance related interactions and interventions into CCA database. Member Outreach: *… more
- CVS Health (Phoenix, AZ)
- …an exciting new opportunity within the Grievances team in Scottsdale, AZ. As the Grievance Associate Manager, you will oversee a team of Grievance Analysts who ... resolution for Medicare D (Med D) Grievances. In this Grievance Associate Manager role, you will handle coaching, mentoring,...potential issues related to process and procedures. As a Grievance Associate Manager, you will: - Lead the team… more
- VNS Health (Manhattan, NY)
- …maintains accurate records documenting the actions and rationale for each grievance or appeal decision. Develops correspondence communicating the outcome of ... and assists with compiling reports and analysis on the grievance and appeals process. For Fair Hearings: + Supports... and appeals process. For Fair Hearings: + Supports Grievance and Appeals on legal issues pertaining to State… more
- Elevance Health (Mason, OH)
- …plan risk, ensures quality, and regulatory compliance.** PRIMARY DUTIES: + Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings. + Leads ... grievance and appeals in regulated audits. + Analyzes large...thresholds within budgetary guidelines. + Monitors trends and analyzes grievance and appeals data to identify and recommend plan… more
- Centene Corporation (Phoenix, AZ)
- …Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals Committee + Support the pay-for-performance programs, including data ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral,… more
- CVS Health (Phoenix, AZ)
- …new opportunity within the Grievances team in Scottsdale, AZ. As a Grievance Analyst, you will be responsible for researching, resolving, and communicating any ... Management (PBM) or pharmaceutical related industry. - Previous Med D grievance experience. - Bachelors Degree Preferred. **Education** High School Diploma or… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Grievance and Appeals Coordinator 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #660 Tuesday, November 5, 2024 Centers Plan for Healthy Living's goal is to ... they need for healthy living. JOB SUMMARY: As an integral part of the Grievance and Appeals (G&A) Department, the G&A Coordinator lends their support in processing… more
- BayCare Health System (Clearwater, FL)
- …regulatory requirements. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring all necessary documentation ... be working remotely? Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist-Health Plan **Location** Clearwater:Park Place | Business and… more
- ManpowerGroup (Rancho Cucamonga, CA)
- **Title: Temporary Coordinator - Grievance and Appeals** **Location:** **Rancho Cucamonga California 91730 (Hybrid)** **Schedule: Telecommute (once or twice a month ... Contract** **Pay Range $20.00 to $23.98/hr.** We are looking for a "Temporary Coordinator - Grievance and Appeals" to join one of our Fortune 500 clients. This is a… more
- Humana (Columbus, OH)
- …improving consumer experiences **Preferred Qualifications** + Previous experience working in Grievance and Appeals + Beginner knowledge in Microsoft PowerPoint and ... Access + General understanding of healthcare economic, financial and operational concepts + Results oriented; problem solver + Bilingual English/Spanish - must be able to speak, read and write in both languages without limitations or assistance **WORK STYLE:**… more
- Health First (Rockledge, FL)
- …Insurance)* **Organization:** **HF Administrative Plan Inc* **Title:** *HFHP Appeal / Grievance Coordinator - Member Appeals Grievances* **Location:** *Florida - ... Brevard County-Rockledge* **Requisition ID:** *075564* more
- CareFirst (Baltimore, MD)
- …evaluate clinical quality and procedures within the Clinical Appeals & Grievance Department Government Programs (Maryland Medicare and Medicaid). This includes ... auditing clinical appeals and grievance letters/documentation, reporting and analysis to ensure compliance with regulatory standards and assisting with department… more
- Bassett Healthcare (Cooperstown, NY)
- …processes to analyze and report patient safety, risk management and patient grievance data. The Director supports compliance with federal and state regulations and ... strategies and tactics for patient and staff safety and patient grievance programs. Institutes corrective actions and/or makes modifications to safety and… more
- Corewell Health (Royal Oak, MI)
- …assists stakeholder and process owners in prioritizing improvement opportunities. + Grievance : Provide access to a centrally located positive patient feedback and ... grievance process- Receive and review complaints and grievances from...accurate depth of clinical review. + Compile and prepare complaint/ grievance that is not resolved the satisfaction of the… more
- Michigan State University (East Lansing, MI)
- …a procedural advisor to parties (claimants and respondents) in the grievance process/procedures outlined in discrimination and harassment policies enforced by MSU's ... accompanies the party to meetings and interviews related to the grievance process/procedures, advises the party on that process, and conducts cross-examination… more
- Elevance Health (Walnut Creek, CA)
- **Manager II Grievance /Appeals (RN)-California** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 ... **Costa Mesa** + **Palo Alto** + **Walnut Creek** The **Manager II Grievance /Appeals** is responsible for management oversight of grievances and appeals departmental… more
- Cedar Falls Community School District (Cedar Falls, IA)
- …provide staff development on matters of contract administration. + To prepare grievance responses and plan management's positions for grievance arbitration. + ... Cedar Falls Community School District has the required Board policies and grievance procedures in place. + Ensure that information about the non-discrimination… more
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