• Manager, Grievance and Appeals, RN

    VNS Health (Manhattan, NY)
    …Also monitors and audits subcontractors who have delegated responsibility for managing grievance and appeals on behalf of the plan to ensure operational and ... file and data collection systems and prepares data reports and analysis of grievance and appeals for program management and committees, as needed. Works under… more
    VNS Health (09/04/24)
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  • Appeal and Grievance Coordinator - MUST…

    CVS Health (Richmond, VA)
    …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
    CVS Health (11/03/24)
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  • Grievance Analyst (Senior/Case Reviewer)

    CVS Health (Phoenix, AZ)
    …exciting new opportunity within the Grievances team in Scottsdale, AZ. As a Grievance Analyst, you will be responsible for ensuring Grievance resolutions address ... are a direct result of the quality process. The Grievance Analyst will also complete full root-cause analysis functions,...include providing support to various operational teams within the Grievance department, as needed. This may include working … more
    CVS Health (11/01/24)
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  • Appeals & Grievance Specialist

    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 are ... verbal and written correspondence. - Thoroughly document all member appeal and grievance related interactions and interventions into CCA database. - Member Outreach:… more
    Commonwealth Care Alliance (09/07/24)
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  • Grievance /Appeals Analyst I (US)

    Elevance Health (Indianapolis, IN)
    **Title: Grievance /Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of ... our PulsePoint locations. The ** Grievance /Appeals Analyst I** is an entry level position in...I** is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes… more
    Elevance Health (10/29/24)
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  • Grievance /Appeals Analyst Lead

    Elevance Health (Richmond, VA)
    **Title: Grievance /Appeals Analyst Lead** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of a ... California PulsePoint location. The ** Grievance /Appeals Analyst Lead** will be responsible for leading and...be responsible for leading and coaching a team of Grievance & Appeals Analysts in the Enterprise Grievance more
    Elevance Health (10/25/24)
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  • Grievance /Appeals Analyst I (California…

    Elevance Health (Los Angeles, CA)
    **Title: Grievance /Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of ... our PulsePoint locations. The ** Grievance /Appeals Analyst I** is an entry level position in...I** is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes… more
    Elevance Health (10/11/24)
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  • Grievance /Appeals Analyst Lead

    Elevance Health (Norfolk, VA)
    ** Grievance /Appeals Analyst Lead** **Candidates must be located within 50 miles of Atlanta, GA, Miami, FL, Mason, OH, Norfolk, VA, Tampa, FL, or Topeka, KS** The ** ... Grievance /Appeals Analyst Lead** is responsible for leading and coaching a team of Grievance & Appeals Analysts in the Enterprise Grievance & Appeals… more
    Elevance Health (10/11/24)
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  • Associate Manager, Grievance

    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
    CVS Health (11/01/24)
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  • Specialist, Grievance and Appeals

    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
    VNS Health (10/25/24)
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  • Grievance & Appeals Coordinator

    Elevance Health (Meridian, ID)
    **Title: Grievance & Appeals Coordinator** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The ** Grievance & Appeals Coordinator** is responsible for investigating and...inquiries, grievances and appeals, prepares case files for member grievance committees/hearings. **How you will make an impact:** ​… more
    Elevance Health (11/02/24)
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  • Grievance & Appeals Coordinator I

    Centene Corporation (Springfield, IL)
    …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
    Centene Corporation (11/02/24)
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  • Appeals and Grievance Specialist…

    Baylor Scott & White Health (Temple, TX)
    **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for all lines of business....+ Builds case files for each complaint, appeal and grievance , and ensures compliance with organizational and regulatory guidelines.… more
    Baylor Scott & White Health (10/30/24)
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  • Grievance and Appeals Specialist, Clinical

    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. + Participates in special projects...care, including a minimum of two years in a grievance and appeals or related area such as medical… more
    VNS Health (09/20/24)
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  • Grievance /Appeals Representative I

    Elevance Health (Meridian, ID)
    **Title: Grievance /Appeals Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The ** Grievance /Appeals Representative I** is responsible for reviewing, analyzing and processing claims in accordance with policies… more
    Elevance Health (11/02/24)
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  • Grievance Specialist-Health Plan

    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
    BayCare Health System (10/24/24)
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  • Provider Grievance and Appeals Program…

    Elevance Health (KS)
    ** Grievance and Appeals Program Manager, Senior** **Location:** Kansas. This position will work a hybrid model (remote and office). The ideal candidate will live ... 50 miles of one of our Kansas Elevance Health PulsePoint locations. The ** Grievance and Appeals Program Manager, Senior​** will be responsible for managing Provider… more
    Elevance Health (10/22/24)
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  • Temporary Coordinator - Grievance

    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
    ManpowerGroup (10/17/24)
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  • Grievance and Appeals Coordinator

    Centers Plan for Healthy Living (Staten Island, NY)
    Grievance and Appeals Coordinator 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #660 Wednesday, October 9, 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
    Centers Plan for Healthy Living (10/11/24)
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  • RN - Grievance and Appeals Clinical…

    Centers Plan for Healthy Living (Margate, FL)
    RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, October 7, 2024 Centers Plan for Healthy Living's goal is to ... the guidance and plans they need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial… more
    Centers Plan for Healthy Living (10/08/24)
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