- Elevance Health (Mason, OH)
- …and 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 data sets using advanced knowledge of ETL data processing methods. + Designs and builds ad hoc… more
- Centene Corporation (Phoenix, AZ)
- …member and provider complaints, grievances and appeals + Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims or related managed care experience. Strong oral, written,… more
- Humana (Columbus, OH)
- …improving consumer experiences **Preferred Qualifications** + Previous experience working in Grievance and Appeals + Beginner knowledge in Microsoft PowerPoint ... help us put health first** The Supervisor, Grievances & Appeals is an inventory based role, supporting a team...also support quality related go The Supervisor, Grievances & Appeals is an inventory based role, supporting a team… 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
- 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 ... 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
- 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
- Commonwealth Care Alliance (Boston, MA)
- CCA- Appeals & Grievances Processing of Grievances & Appeals : * Responsible for the progress of grievance and appeal intervention and resolution. * Assure ... pharmacy, dental, reporting, and member services. * Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day tasks and assignments.… 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
- 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 ... + **Costa Mesa** + **Palo Alto** + **Walnut Creek** The **Manager II Grievance / Appeals ** is responsible for management oversight of grievances and appeals … more
- CVS Health (Salem, OR)
- …ABMS 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 . * Direct daily work on part C appeals (both provider and member/nonparticipating providers). * Provide direct… more
- Humana (Indianapolis, IN)
- …+ 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)
- …Nurse Specialist LVN II is primarily responsible for the overall coordination of the Appeals & Grievance (A&G) program for LA Care Health Plan members under ... 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
- Apex Health Solutions (Houston, TX)
- …safety, cost efficiency and a commitment to the Continuous Quality Improvement Process. The Appeals & Grievance Coordinator will interact on a daily basis with ... Summary: The Appeals and Grievances coordinator position is focused on...the processing of customer and provider Medicare and Commercial appeals and grievances. This associate may screen incoming complaints,… more
- Apex Health Solutions (Houston, TX)
- …cost efficiency and a commitment to the Continuous Quality Improvement Process. The Appeals & Grievance Coordinator, Senior, will interact on a daily basis ... Summary: The Appeals and Grievances coordinator, Senior position, is focused...the processing of customer and provider Medicare and Commercial appeals and grievances. This associate may screen incoming complaints,… 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
- BayCare Health System (Clearwater, FL)
- …ensuring adherence to regulatory requirements. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring ... be working remotely? Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist-Health Plan **Location** Clearwater:Park Place | Business and… more
- Geisinger (Danville, PA)
- Job Summary Provides support in administration of the Appeals and Grievance process. Serves as a liaison between Members and the Plan with appeals regarding ... Health Plan and external entities, communicating with all entities involved throughout the appeals and grievance process. + Maintains strict compliance with all… 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
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