- Point32Health (Canton, MA)
- …colleagues and communities. **Job Summary** SUMMARY Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and ... more
- VNS Health (Manhattan, NY)
- …to established procedures. Maintains confidentiality of information. + Maintains knowledge of Grievance and Appeals (G&A) procedures, and CMS and DOH regulatory ... more
- AmeriHealth Caritas (Philadelphia, PA)
- …of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial ... more
- Highmark Health (Pittsburgh, PA)
- …This position is also responsible for assisting members in navigating the grievance and appeals process and representing member interests internally and ... more
- CVS Health (Dover, DE)
- …contract. + Process claim referrals, new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists providers with ... more
- Highmark Health (Springfield, IL)
- …and member requests, received from Medical Management & Policy (MM&P) and Member Grievance Departments. * Responsible for management of Peer to Peer telephone line. ... more
- State of Colorado (Chaffee County, CO)
- …responding to offender disciplinary appeals , answering offender classification appeals , review of offender grievance responses, and gathering information ... more
- State of Colorado (CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... more
- Humana (Madison, WI)
- …Review Level of Care for iCare members including follow-up consultation with Grievance and Appeals or Enrollment/Eligibility/Fiscal staff. * Provide appropriate ... more
- LA Care Health Plan (Los Angeles, CA)
- …Oversee overtime work and will produce accurate accounting of each representative work performance. Conducting evaluations of and implementing enhancements to the ... more
- City and County of San Francisco (San Francisco, CA)
- …the City in state and federal civil litigation (through trial and appeals ) and administrative proceedings involving labor and employment matters and provides ... more
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