- Health First (Melbourne, FL)
- …Health Plans (Health Insurance)* **Organization:** **HF Administrative Plan Inc* **Title:** * Manager Complaints, Grievances , and Appeals * **Location:** ... to resolve internal operational issues that may cause increase to member appeals / grievances volumes and drive operational efficiencies. 10. Maintain technical… more
- Elevance Health (Walnut Creek, CA)
- …**Costa Mesa** + **Palo Alto** + **Walnut Creek** The ** Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals ... ** Manager II Grievance/ Appeals (RN)-California** **Location** :...departmental units to investigate, resolve, and respond to grievances and appeals , manages inventory and production… more
- VNS Health (Manhattan, NY)
- …Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances . + Ensures the accuracy and integrity of data ... of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals (RN)to lead the...Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long… more
- Apex Health Solutions (Houston, TX)
- Summary: The Appeals and Grievances coordinator, Senior position, is focused on the processing of customer and provider Medicare and Commercial appeals and ... staff Adverse Determination and Appeals Tracking Coordination of Appeals , Adverse Determinations and Grievances Corresponds with members, providers… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN...culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the A&G Leadership in… more
- Elevance Health (Mason, OH)
- …of a relevant Elevance Health location. **Responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond ... to grievances and appeals , manages inventory and production...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CVS Health (Olympia, WA)
- … appeals and complaints. Responsible for day-to-day implementation of Aetna's appeals , complaints and grievances policies and procedures. Identifies trends ... the United States. Manage the effective resolution of Medicare Participating Provider Appeals & Complaints. Responsible for the day-to-day management of staff to… more
- CareFirst (Baltimore, MD)
- …educational and training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in the development and ... data related to the volume and complexity of the appeals and grievances submitted for resolution. **SUPERVISORY...Licensure Upon Hire Required. + CCM - Certified Case Manager Upon Hire Preferred. + LNCC - Legal Nurse… more
- Elevance Health (Los Angeles, CA)
- …or deny appeal and forwards to Medical Director for approval. + 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...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Conduent (Hamilton, NJ)
- …and Health Services (DMAHS) of New Jersey. **Reports To** This position reports to the Appeals Supervisor and the Appeals Manager . The Appeals ... individuality is noticed and valued every day. Fair Hearing Appeals Agent $18.50/ Hourly Onsite- Hamilton, NJ Full-time and...for an appeal (Fair Hearings for Plan A and Grievances for Plans B, C, and D) in a… more
- Medical Mutual of Ohio (OH)
- …new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances , and Medicare marketing material requirements. . Assists ... new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances , and Medicare marketing material requirements. . Assists… more
- Highmark Health (Pittsburgh, PA)
- …for members, improving payment integrity, and optimizing the experience of denials, appeals , and grievances . The ideal candidate outlines the strategic vision ... **.** This includes a strong grasp of claims intake, adjudication, payment, appeals , denials, and grievances along with familiarity with various claim… more
- Maryland Department of Transportation (Anne Arundel County, MD)
- …of Transportation for Second Step grievance appeals and disciplinary action appeals . + Negotiating the dispositions of grievances or disciplinary actions ... Labor Relations Manager (DOT Executive IV) Salary $95,991.00 - $154,928.00...skilled leader to serve as our next Labor Relations Manager (DOT Executive IV) . The Labor Relations … more
- State of Colorado (Colorado Springs, CO)
- …and techniques or recommend adjustments to policy and functions or services; INVESTIGATIONS/ GRIEVANCES + Serve as the initial contact and liaison for intake and ... + Assist in conducting objective and thorough internal investigations of grievances and complaints, and assist in recommending appropriate action; + Review… more
- State of Colorado (CO)
- …Provide professional guidance to appointing authorities and employees regarding grievances , 1450-05 and appeal processes; + Investigate complaints of discrimination ... policy, State Personnel Board Rules, legal precedence, and DOC performance standards. Appeals & Legal Case- Requests for Information + Exercise discretion and… more
- Point32Health (Canton, MA)
- …met + Track stakeholder feedback on product performance throughout the year, including Appeals & Grievances to help inform future benefit design guidance, ... at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Senior Manager of Product Implementation and Administration will have two main… more
- Sacramento County (Sacramento, CA)
- Human Services Division Manager Range A/B Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/2234944) Apply Human Services Division Manager ... $12,042.50 - $14,636.88/month Under executive direction, the Human Services Division Manager plans, coordinates and administers a human services division comprised… more
- Sacramento County (Sacramento, CA)
- Human Services Program Manager Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/2751183) Apply Human Services Program Manager Salary ... 12/4/2024, 12/18/2024 (Final) Under direction, the Human Services Program Manager plans, coordinates and manages the work of a...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more
- LA Care Health Plan (Los Angeles, CA)
- …Management, Risk Adjustment, Products, Customer Solution Center (CSC), reporting and Analytics, Appeals and Grievances and the provider network. Manage and ... Clinical Quality Program Manager III Job Category: Clinical Department: Quality Improvement...achieve that purpose. Job Summary The Clinical Quality Program Manager is responsible for identifying, implementing, and guiding projects… more
- Elevance Health (Columbus, OH)
- …in partnership with blue cross blue shield plans. Our Government Health Benefits Grievances and Appeals , Enrollment, and Billing Organization is looking to hire ... with health plan operations and back office, Medicare, Medicaid, Grievances & Appeals (G&A), Enrollment, and Billing....Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
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