- Elevance Health (Richmond, VA)
- **Title: Grievance / Appeals Analyst II** **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 II** will be responsible for reviewing, analyzing and processing non-complex and some complex… more
- 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 the Enterprise Grievance & Appeals Department that… more
- Elevance Health (Woodland Hills, 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
- Centene Corporation (Tempe, AZ)
- …**Position Purpose:** Analyze and resolve verbal and written claims and authorization grievance / appeals from providers and members. Resolve all State inquires ... decisions. * Act as subject matter expert regarding grievances and appeals . * Lead Appeals and Grievance Committee Education/Experience: Bachelor's degree in… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Grievance and Appeals Coordinator 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #660 Monday, July 1, 2024 Centers Plan for Healthy Living's goal is to ... 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 (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, July 1, 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
- CVS Health (Columbus, OH)
- …solutions to make health care more personal, convenient and affordable. Position SummaryCreated grievance and appeals cases in the G&A system and sends ... acknowledgement letters to members and providersRequired QualificationsData Entry SkillsPreferred QualificationsOrganized, ability to multi-task, Detail orientedEducationHigh Scholl Diploma or GED Pay Range The typical pay range for this role is: $17.00 -… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH Appeals… more
- Centene Corporation (Tallahassee, FL)
- …As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Qualified candidates must ... reside in Florida **Position Purpose:** Perform various analysis and interpretation to link business needs and objectives for assigned function. + Support business initiatives through data analysis, identification of implementation barriers and user acceptance… more
- CVS Health (Hartford, CT)
- …Recognized Specialty Preferred Qualifications * Medical Management - Medicare Complaints, Grievance & Appeals experience.* Health Plan Experience Highly ... of this Medical Director role are related to Medicare Appeals .* Direct daily work on part C appeals... Appeals .* Direct daily work on part C appeals (both provider and member/nonparticipating providers) and Part D… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: At least 5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services ... Manager, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department:...Coordinates, tracks, and resolves internal and external appeal and grievance complaints for LA Care Plan Partners, including identifying… more
- LA Care Health Plan (Los Angeles, CA)
- …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... and evaluation by the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB to identify areas of improvement to assist the… more
- Molina Healthcare (Lexington, KY)
- …**Job Summary** Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and ... tracking system and database of correspondence and outcomes for provider and member appeals ; monitors each appeal to ensure all internal and regulatory timelines are… more
- LA Care Health Plan (Los Angeles, CA)
- … Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals & Grievance Specialists by handling the administrative functions of the ... clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory timelines by maintaining… more
- LA Care Health Plan (Los Angeles, CA)
- …Nurse Specialist LVN II is primarily responsible for the overall coordination of the Appeals & Grievance program for LA Care Health Plan members under the ... Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job...and recommendations, mailing and faxing of resolution letters. Reviews grievance cases that require immediate clinical quality of care,… more
- CareOregon (Portland, OR)
- …and authorization process and team. + Analyze, identify, elevate, and resolve complaint, grievance and appeals trends. + Analyze, identify, elevate, and resolve ... Compliance and Regulatory + Ensure compliance with authorization, complaint, and grievance / appeals timelines. + Ensure all compliance and regulatory requirements… 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 (Charleston, WV)
- …for complex cases, in the authorization and denial of services, and in the grievance and appeals process. + Assist in monitoring effectiveness of physician ... assure ongoing relationships with the corporation maximize their effectiveness. + Grievances and Appeals - Assist in the evaluation and resolution of grievances and … more
- CVS Health (Columbus, OH)
- …management, care management, claims adjudication, pharmacy utilization, quality improvement, grievance and appeals , policies and procedures, and responsible ... review, discharge planning, and medical reviews performed through the aligned plan's grievance and appeal system. . Leads the administration of all medical… more
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