- Elevance Health (Mason, OH)
- **Manager II Grievance / Appeals (RN)- Claims Support** **Location** : This position will work in a hybrid model (remote and office). Ideal candidates will live ... locations. Expected Work Hours: Monday-Friday; 8AM-5PM EST The **Manager II Grievance / Appeals ** is responsible for management oversight of grievances and… more
- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our ... grievance and appeals processes. You will play a crucial role in...assure all are educated and compliant with requirements of appeals and grievance regulations and processing. +… more
- VNS Health (Manhattan, NY)
- …criteria. + Enters data and assists with compiling reports and analysis on the grievance and appeals process. For Fair Hearings: + Supports Grievance ... to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in defense of the appeals… more
- ManpowerGroup (Rancho Cucamonga, CA)
- **Title: Temporary Coordinator - Grievance and Appeals ** **Location:** **Rancho Cucamonga California 91730 (Hybrid)** **Schedule: Telecommute (once or twice a ... 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 **Bilingual… more
- G-TECH Services, Inc. (Detroit, MI)
- …Multi-task Preferred Skills/Experience - Optional but preferred skills/experience. Include: * Grievance and Appeals experience. * Degree in Healthcare/computer ... Process appeals and grievances, analyze, research, and provide comprehensive...analyzing a claim * Experience in classification between a grievance /appeal/organizational determination. * Letter writing * Basic computer skills.… more
- Point32Health (TX)
- …here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- 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. Responsibilities include, but are not limited to: timely classification and… more
- Elevance Health (Columbus, OH)
- **Manager II Grievance / Appeals (RN)-California** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within ... locations. **Expected Work Hours:** Monday-Friday; 8am-5pm PST The **Manager II Grievance / Appeals ** is responsible for management oversight of grievances and… more
- Corewell Health (Grand Rapids, MI)
- …policies which may impact the appeal and review process + Previous experience with grievance and appeals processes. About Corewell Health As a team member at ... Health - 1231 E Beltline - Grand Rapids Department Name PH - Grievance And Appeals Medicare Employment Type Full time Shift Day (United States of America) Weekly… more
- CVS Health (Hartford, CT)
- …ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly ... this Medical Director role are related to Regulated Medicare Appeals : * Direct daily work on part C ...Appeals : * Direct daily work on part C appeals (both provider and member/nonparticipating providers). * Provide direct… more
- Humana (Columbus, OH)
- …+ Previous inbound call center or related customer service experience + Grievance and appeals experience + Previous experience processing medical authorizations ... and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by...review of clinical documentation to determine if an a grievance , appeal or further request is warranted and then… more
- LA Care Health Plan (Los Angeles, CA)
- …Grievances is responsible for assisting with the development of a successful and cohesive Appeals and Grievance unit, with a high level of productivity to ... member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing feedback on performance,… more
- CareFirst (Baltimore, MD)
- …membership, and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an experienced people ... field, Legal Nurse Consultant, Utilization Management, and Government Program experience with Appeals and Grievance , Experience with MCG, InterQual, NCD and… more
- CareFirst (Baltimore, MD)
- …3 years supervisory experience Utilization Management, and Government Program experience with Appeals and Grievance , Experience with MCG, InterQual, NCD and ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate...serves as a resource for associates within the Clinical Appeals and Analysis unit supporting Government Programs lines of… more
- CVS Health (Charleston, WV)
- …of responses from multiple business 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 published business… more
- Elevance Health (Los Angeles, CA)
- …and compliance. **How you will make an impact:** + Supporting customer service and grievance & appeals IT execution + Responsible for supporting annual planning, ... preferred + Healthcare experience including customer service, contact center technology and grievance and appeals platforms strongly preferred + Ability to work… more
- LA Care Health Plan (Los Angeles, CA)
- …all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters ... inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance /appeal requests, and prepares UM Activity and Weekly Compliance… more
- Humana (Columbus, OH)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for… more
- Humana (Columbus, OH)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.… more
- Highmark Health (Dover, DE)
- …This position is also responsible for assisting members in navigating the grievance and appeals process and representing member interests internally and ... Service **Preferred** + Familiarity as a Member Advocate or with complaint and grievance processes + Familiarity with Delaware Medicaid and the Medicaid LTSS benefit… more
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