- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and ... of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.… more
- Sutter Health (Modesto, CA)
- **Organization:** MMC-Memorial Medical Center **Position Overview:** The Grievances & Appeals Specialist supports the patient and family experience through the ... investigation of patient/family complaints, concerns, and other feedback received by the organizations. Complaints and grievances include, but are not limited to, the care provided by physicians and other health care professionals, potential liability, quality… more
- VNS Health (Manhattan, NY)
- …criteria. + Enters data and assists with compiling reports and analysis on the grievance and appeals process. + Participates in special projects and performs ... experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required +… more
- Commonwealth Care Alliance (Boston, MA)
- …to appeal and grievances. **What You'll Be Doing:** - Processing of Grievances & Appeals . - Responsible for the progress of grievance and appeal intervention and ... pharmacy, dental, reporting, and member services. - Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day tasks and assignments.… more
- LA Care Health Plan (Los Angeles, CA)
- …meet and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing ... assisting with the development of a successful and cohesive Appeals and Grievance unit, with a high...and or process improvement. Assist Supervisor to ensure that Specialist provide accurate, timely, and quality responses. Ensure that… more
- BayCare Health System (Clearwater, FL)
- …be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist -Health Plan **Location** Clearwater:Park Place | ... to regulatory requirements. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring all necessary… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... grievance process that meets state, federal, accreditation and other...knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests,… more
- Maryland Department of Transportation (Baltimore City County, MD)
- Labor Relations Specialist (Administrator III) Salary $69,323.00 - $112,044.00 Annually Location Baltimore City Job Type Full Time Job Number ... + Benefits + Questions Description MARYLAND TRANSIT ADMINISTRATION Labor Relations Specialist (Administrator III) (2588) Grade 18 Career Service Open to all… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …determined within appropriate timeframes. This position will serve as a liaison to the Grievance and Appeals Department for Medicare Advantage appeals . The ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews,...to services being rendered for members. The Utilization Review Specialist (LVN) serves as a liaison in reviewing requests… more
- State of Colorado (CO)
- …met; + Provide guidance to ERU staff on active discrimination/ harassment investigations, grievance panels, ADA, appeals , and other concerns; + Represent the ... CDOC - Human Resources Specialist IV (Employee Relations Work Lead) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4650990) Apply CDOC -… more
- State of Colorado (CO)
- Employee and Labor Relations (ELR) Specialist Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4675745) Apply Employee and Labor Relations ... (ELR) Specialist Salary $57,708.00 - $92,340.00 Annually Location Statewide, CO...& Labor Relations Manager to resolve complaints in coordinating grievance procedures and fully working through the process with… more
- Elevance Health (Grand Prairie, TX)
- …of customer service and manages adjustments, ITS processing, keying, rate negotiation, grievance and appeals , escalations, etc., in providing a seamless Blue ... **Title: Plan to Plan Service Specialist III** **Location:** This position will work a...internal business partners (sales, member experience, claims, medical review, appeals , etc.) and external contacts within the other Blues… more
- Naval Air Systems Command (Patuxent River, MD)
- Summary You will serve as a HUMAN RESOURCES SPECIALIST (LABOR AND EMPLOYEE RELATIONS) in the HUMAN CAPITAL MANAGEMENT GROUP of NAVAIRWARCENAC DIV. Responsibilities ... matters such as performance, conduct, discipline, adverse actions, grievances, and appeals to maintain a productive climate of employer-employee relationships. You… more
- Montana State University (Bozeman, MT)
- …please contact: Laura Larsson ###@montana.edu ### Classification Title Student Support Specialist Working Title CO-OP Student Success Specialist Brief Position ... for the Caring for Our Own Program (CO-OP), the CO-OP Student Success Specialist is responsible for guiding students from prospective status through enrollment at… more
- Veterans Benefits Administration (Huntington, WV)
- Summary The Supervisory Program Specialist shares responsibility fully with the Director for the effective, efficient, and economical direction, control, and ... and support of the federally administered veterans' programs. The Supervisory Program Specialist represents and acts for the Director, the Secretary of Veterans… more
- Trinity Health (Woodlyn, PA)
- …the Quality and Compliance Director and maintain infection control programs. + Support grievance and appeals processes and contribute to the development and ... Type:** Full time **Shift:** **Description:** **Job Title: Quality and Compliance Specialist ** **Ministry: Trinity Health PACE** **Position Purpose:** As the Quality… more
- Transportation Security Administration (Bridgeton, MO)
- …segment are consistent with Merit System Principles. Review decision letters regarding appeals and grievance for accuracy prior to delivery. Formulate creative ... freedom of movement for people and commerce. Responsibilities This Human Resources Specialist position is located at Lambert St. Louis International Airport (STL),… more
- Centene Corporation (Phoenix, AZ)
- …Purpose:** Documents and addresses customer complaints and issues (Ie, grievances, appeals , Claims Tracking Module) based on regulatory requirements. Supports and ... perform independent decision making, and manage time effectively preferred. Experience in Grievance and healthcare is highly preferred. Pay Range: $17.17 - $26.97… more
- US Army Civilian Human Resources Agency (Fort Riley, KS)
- …advisor with personnel and management officials in the resolution of grievances, appeals , audit reports, and complaints arising out of the processing of benefits ... and decisions; informing employees about their entitlements and use of grievance or appeal procedures. This definition of specialized experience is typical… more