- 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)
- **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
- Evolent (Springfield, IL)
- …**Required** + Minimum of 5 years in Utilization Management, health care Appeals , compliance and/or grievances /complaints in a quality improvement environment- ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...to 7pm CST (which includes 30-minute unpaid lunch break) 3 days/week, to meet the business needs of nurses… more
- Henry Ford Health System (Troy, MI)
- …for the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare ... + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from:...healthcare or a related field. + Minimum of three ( 3 ) years of experience in a Customer Service or… more
- State of Colorado (Pueblo, CO)
- …This position ensures compliance with nondiscrimination policies and manages grievances related to discrimination. This position manages complaints, develops ... + Review of videos involving physical response, abuse allegations, and youth grievances (if applicable). Additional reviews as required by the Youth Center… more
- State of Colorado (Canon City, CO)
- …interviews; schedules staffing patterns; approves training opportunities; and resolves complaints/ grievances at the informal level; + Trains and instructs staff ... or sales, project management and bidding projects . OR: A minimum of three ( 3 ) years of experience, as described above may be combined with experience in a… more
- BayCare Health System (Clearwater, FL)
- …provide updates to management. + Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future ... respect, responsibility and clinical excellence. **Summary:** + Manages intricate grievances , collaborating closely with healthcare providers and members to resolve… more
- State of Colorado (Lakewood, CO)
- …employment laws, progressive discipline, records management, recruitment, responding to grievances , appeals , charges of discrimination, reorganization matters, ... retention, selection and selection appeals , worker's compensation, settlement advice, strategic planning and overall...(7) years of professional experience with at least three ( 3 ) years in LMS operation, functional aspects, vendor negotiation,… more
- Cognizant (Salem, OR)
- …or clinic operations + Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews + ... + Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- State of Colorado (Golden, CO)
- …development training (as available) + Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, in ... for all youth + Responds to and resolves youth grievances + Act as first public contact with agency...should not disqualify the applicant from the current position, ( 3 ) provide the employee number from the applicant's prior… more
- State of Colorado (Greeley, CO)
- …professional development training (as available). Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, ... interventions for all youth. Responds to and resolves youth grievances . Act as first public contact with agency when...should not disqualify the applicant from the current position, ( 3 ) provide the employee number from the applicant's prior… 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
- Aston Carter (Nashville, TN)
- …Service Representative 3Job Description The role of a Customer Service Representative 3 is to interact with customers by providing information in response to ... investigation results and any planned adjustments. + Refer unresolved customer grievances to designated departments for further investigation. + Keep records of… more
- City of New York (New York, NY)
- …relations and union related matters, as well as represents ACS in Step II grievances appeals and issuing determinations on these matters. ACS Labor Relations ... conducting hearings and providing written responses to Step II grievances . - Represent ACS at Step III hearings, presenting...area related to the duties as described above; or 3 . Education and/or experience which is equivalent to "1"… more
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more
- Transdev (Dorchester, MA)
- …of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal requirements and ... (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
- MTA (New York, NY)
- …and participate in monthly conferences with union representatives to discuss contract grievances and employee discipline appeals ; perform analytical review of ... Authority is North America's largest transportation network, serving a population of 15. 3 million people across a 5,000-square-mile travel area surrounding New York… more
- Molina Healthcare (AZ)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
- City and County of San Francisco (San Francisco, CA)
- …bargaining agreements. + Key duties include negotiating resolutions to grievances , investigating complaints of serious employee misconduct, and conferring with ... degree from an accredited college or university. Experience: Three ( 3 ) years of verifiable professional human resources experience, similar...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- Sacramento County (Sacramento, CA)
- …are at 5:00 pm on: 9/26/2025, 10/24/2025, 11/26/25, 12/26/25, 1/23/26, 2/27/26, 3 /27/26, 4/24/26, 5/22/26, 6/26/26 Nurse Practitioners provide a range of health care ... Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days...Pay a fair share fee to the union; or, 3 . Meet specific requirements under which an equivalent amount… more
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