- Elevance Health (Columbus, OH)
- …**Expected Work Hours:** Monday-Friday; 8am-5pm PST The ** Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and ... ** 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
- 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 (Harrisburg, PA)
- … Department that reviews analyzes and processes non-complex pre-service and post-service grievances and appeals requests from customer types (ie member, ... make an impact:** + Reviews analyzes, and processes non-complex grievances and appeals by external accreditation and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Mason, OH)
- …locations. Expected Work Hours: Monday-Friday; 8AM-5PM EST The ** Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and ... ** Manager II Grievance/ Appeals (RN)- Claims Support**...departmental units to investigate, resolve, and respond to client/provider grievances / appeals and ensure compliance with regulatory requirements.… 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 (Palo Alto, 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
- 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
- CareOregon (Portland, OR)
- …subcontracted entities, fraud waste and abuse prevention planning and investigations, grievances , hearings and appeals , corporate risk assessment and compliance ... Job Title Delegation and Quality Oversight Manager Exemption Status Exempt Department Health Share of...collection, file maintenance, reporting and resolution of the hearings, appeals and grievances processes. + Develop and… more
- State of Colorado (Golden, CO)
- Office of Public Safety Communications Microwave Manager Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4772302) Apply Office of Public ... Safety Communications Microwave Manager Salary $115,740.00 - $170,964.00 Annually Location Golden, CO...employee conflicts and respond to both informal and formal grievances as delegated. Participates in team hiring process. Staff… more
- HCA Healthcare (Rochester, NH)
- …colleagues invested over 156,000 hours volunteering in our communities. As a RN Manager Behavioral Health with Frisbie Memorial Hospital you can be a part of ... need to succeed in our organization. We are looking for an enthusiastic RN Manager Behavioral Health to help us reach our goals. Unlock your potential! **Job Summary… more
- State of Colorado (Golden, CO)
- Office of Public Safety Communications Manager - Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4758741) Apply Office of Public Safety ... Communications Manager - Denver Salary $104,976.00 - $155,064.00 Annually Location Golden,...employee conflicts and respond to both informal and formal grievances as delegated. Participates in team hiring process. Staff… 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
- J&J Family of Companies (Indianapolis, IN)
- …such as eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ; practice management, as well as Medicare and ... Innovative Medicine is recruiting for a Senior Regional Business Manager , Site of Care, to lead the Great Lakes...we all belong. The role of the Regional Business Manager is to expand the sales of the Immunology… more
- J&J Family of Companies (Austin, TX)
- …such as eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ; practice management, as well as Medicare and ... Innovative Medicine is recruiting for a Senior Regional Business Manager , Site of Care, to lead the South Central...we all belong. The role of the Regional Business Manager is to expand the sales of the Immunology… more
- LA Care Health Plan (Los Angeles, CA)
- …due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters to ... collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory… more
- Robert Half Office Team (Midland, TX)
- …organization, located in Midland, Texas, is actively seeking a proficient Human Resources (HR) Manager to become part of our team. The primary focus of this role is ... investigations in response to employee complaints or concerns * Review employee appeals through the organization's complaint procedure * Support department heads by… more
- Elevance Health (Lakeland, FL)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Roper St. Francis (SC)
- …legal field, customer service or healthcare preferred. Prior experience working with grievances and appeals strongly preferred. Knowledge of RSFH organizational ... Summary** **:** The Patient Relations & Legal Coordinator aids in complaints and grievances management as well as legal matters to include coordinating with outside… more
- State of Colorado (Greeley, CO)
- …This supervision entails assigning and evaluating work, handling informal grievances , initiating corrective and disciplinary actions, and participating in the ... This supervision entails assigning and evaluating work, handling informal grievances , initiating corrective and disciplinary actions, and participating in the… more
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