- Sanford Health (Sioux Falls, SD)
- … appeals and grievances , regulatory oversight, or health policy. At least 3 years in a leadership role managing appeals , grievances , or regulatory ... appeals and grievance resolution. Lead and manage the end-to-end appeals and grievances process for all product lines, ensuring compliance with federal and… more
- Molina Healthcare (Sterling Heights, MI)
- …month Essential Job Duties Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... to work 1 Saturday a month M-F from 7am - 3 :30pm CST will require to work 1 Saturday a...that internal and/or regulatory timelines are met. Researches claims appeals and grievances using support systems to… more
- Elevance Health (Cerritos, CA)
- …Requirements HS diploma or GED. Minimum of 3 years experience working in grievances and appeals , claims, or customer service; or any combination of education ... reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, regulatory and… more
- Transdev (Readville, MA)
- …internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . Understand legal requirements and governmental ... two (2) weeks Sick days: 5 days Holidays: 12 days; 9 standard and 3 floating Other standard benefits: 401(k) retirement plan, medical, dental and vision, life… more
- Molina Healthcare (Racine, WI)
- …related to healthcare premium. Assist in resolution for escalated premium issues with Appeals and Grievances team members. Guide and collaborates with enrollment ... Job Qualifications Required Education High School diploma required Required Experience 3 + years of Member Billing /R Required License, Certification, Association… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: ... required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations...years of clinical acute care experience with at least 3 years of experience with health care grievance and/or… more
- Dignity Health (Rancho Cordova, CA)
- …This position is hybrid in-office and work from home.** **Position Summary:** The Appeals and Grievances Coordinator is responsible for supporting the appeals ... regulatory requirements - facilitating timely and effective resolution of appeals and grievances . Acting a subject matter...similar administrative or coordination role. - Associates degree or 3 years of related job or industry experience in… more
- Dignity Health (Rancho Cordova, CA)
- **Job Summary and Responsibilities** The Appeals and Grievances LVN is a critical role responsible for managing and resolving all medical necessity appeal ... and maintaining patient confidentiality (HIPAA) are also essential. Ultimately, the Appeals and Grievances Nurse monitors denial trends, recommends corrective… more
- Fallon Health (Worcester, MA)
- …other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH ... The Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals & Grievances … more
- Elevance Health (Mason, OH)
- …unless an accommodation is granted as required by law._ The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals ... departmental units to investigate, resolve, and respond to grievances and appeals , manages inventory and production...degree and a minimum of 5+ years grievance & appeals experience and a minimum of 3 … more
- Elevance Health (Indianapolis, IN)
- …and forwards to Medical Director for final review and decision. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + ... skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a...Experiences:** + AS or BS in Nursing preferred. + 3 years of clinical experience as a Registered Nurse… more
- CareFirst (Baltimore, MD)
- …for collecting, organizing and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources. We are ... **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial...**QUALIFICATIONS:** **Education Level:** High School Diploma or GED. **Experience:** 3 years experience in settings such as managed care,… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances addressed to the Member Appeals & Grievances Department. This position will also provide administrative… more
- City of New York (New York, NY)
- …subpoenas on the following: Termination - Tenancy - Leased Housing/Section 8 Subsidy Grievances - Remaining Family Member - Tenant Initiated, such as Rent ... Grievances and Reasonable Accommodation Requests - Leased Housing/Section 8...Calculation and Section 8 Reasonable Accommodation Requests - Over-Income Appeals - Applicant or Trespass - Tenant Reasonable Accommodation… more
- City of New York (New York, NY)
- …United States law school as defined in the Rules of the New York Court of Appeals (Sections 520. 3 or 520.5) or admission to the New York State Bar. Additional ... AHED also represents NYCHA in remaining family member and rent grievances brought by public housing residents and Section 8 participants. Attorneys… more
- City of New York (New York, NY)
- …United States law school as defined in the Rules of the New York Court of Appeals (Sections 520. 3 or 520.5) or admission to the New York State Bar. Additional ... related to labor law and employee discipline. The unit handles employee grievances , prosecutes disciplinary cases, and works with attorneys at the Mayor's Office… more
- CSEA (Albany, NY)
- …of Appeals , NYS DHR, EEOC, Child Abuse Registry; contract grievances and disciplinary arbitration under various state and local collective bargaining agreements; ... in numerous forums, including federal appellate court (Second Circuit, Court of Appeals ); state appellate court in the four departments of the Appellate Division;… more
- CVS Health (Tallahassee, FL)
- …needed and state calls. Understand UM and participate in UM front line work and appeals in markets as needed. * Confer directly with providers regarding the care of ... director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review, and provider appeals … more
- Tufts Medicine (Boston, MA)
- …of experience in Human Resources, Employee Relations, and Labor Relations. 3 . Certification in Human Resources. 4. Process improvement certification (eg, six-sigma). ... a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee Relations… more
- City of New York (New York, NY)
- …issues including license and access issues, leasing, and eminent domain 3 ) procurement related issues including responsive and responsibility issues, bid protests, ... the Uniform Commercial Code ("UCC"); 10) assist division staff with procurement appeals and decision process, including draft opinions and presenting facts and… more
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