- VNS Health (Manhattan, NY)
- …the administration of all BH QM/UM and performance improvement activities, encompassing grievances and appeals , and contributes to various other subcommittees ... leadership and medical director meetings as stipulated by the State BH contract manager . Serves as the principal behavioral health/social care expert and liaison for… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** **Position Summary:** Reporting to the Director of Appeals & Grievances , the Manager , Appeals & Grievances ... Oversight is responsible for the oversight of Plan level appeals and grievances within the Appeals... grievances within the Appeals & Grievances Department and delegated entities. The manager … more
- Elevance Health (Los Angeles, CA)
- ** Manager I - Grievances & Appeals - Member Appeals ** **Location** : This position will work a hybrid model (in office 1-2 days per week). The ideal ... of one of our Elevance Health PulsePoint locations in California. The ** Manager I - Grievances & Appeals ** is responsible for management oversight of… 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 ... OverviewManages the day to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans product lines - Managed Long… more
- Elevance Health (Indianapolis, IN)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, ... an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Los Angeles, CA)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, ... an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… 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
- Elevance Health (Rancho Cordova, 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
- Elevance Health (Los Angeles, CA)
- …entities. + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non ... **Nurse Appeals (Quality) - California candidates only** **Location: This...impact:** Responsible for investigating and processing quality of care grievances from members and providers. **Primary duties may include,… more
- Elevance Health (Topeka, KS)
- …Capabilities and Experiences:** + Experience with Claims, Provider Payments, Provider Grievances , Appeals , administrative hearings, or other legal processes + ... **Provider Grievance and Appeals - Business Change Advisor** **Location: Topeka KS, or...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CareOregon (Portland, OR)
- …customer service, claims processing, prior authorizations, formulary exceptions, appeals , grievances , and project participation. Essential Responsibilities ... formulary exception decisions. + Perform prior authorization reviews with pharmacist oversight. Appeals and Grievances + Explain pharmacy appeal and … more
- Sacramento County (Sacramento, CA)
- Human Resources Manager I Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/3385544) Apply Human Resources Manager I Salary $137,265.12 - ... at 5:00 pm on: 9/20/24, 10/18/24 (final) Positions assigned to Human Resources Manager I, under direction, manage a human resources program that may include… more
- Randstad US (Pleasanton, CA)
- case manager . + pleasanton , california + posted august 20, 2024 **job details** summary + $30 - $31.51 per hour + contract + high school + category computer and ... have a 1 year contract opportunity for a Case Manager in Pleasanton, CA. This position will work from...meet deadlines. Preferred Qualifications: Knowledge of member grievance and appeals process preferred., Knowledge of federal and state laws… more
- State of Colorado (Denver County, CO)
- Manager , Customer Accounts and Variable Data Design - PM I Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4635828) Apply Manager , ... for details on the benefits offered to employees. Description of Job The Manager of Customer Accounts and Variable Data Design reports into the Integrated Document… more
- Washington Metropolitan Area Transit Authority (Washington, DC)
- Contract Manager Job ID: 240287 Location: DC - L'Enfant Plaza Full/Part Time: Full-Time Posting Open-Close 09/10/2024 - 09/24/2024 Union NRP Regular/Temporary: ... the National Contract Management Association (NCMA), the Certified Professional Contracts Manager (CPCM) or an appropriate certificate from a program sponsored by… more
- Point32Health (Canton, MA)
- …action plans; and working collaboratively with other departments such as Appeals and Grievances , Pharmacy, Customer Relations, the Corporate Compliance ... at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Program Manager is responsible for key departmental functions related to the… more
- Point32Health (MA)
- …and accreditation requirements for Care Management, Utilization Management, and / or Member Appeals and Grievances in a health plan setting preferred **Skill ... click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Program Manager is a Registered Nurse who performs program oversight activities… more
- Adecco US, Inc. (South Burlington, VT)
- …products. *Escalate client concerns and utilize core internal resources and systems for grievances and appeals . *Contribute to the performance of the service ... of Client Services and working cohesively with the Executive Manager , the core objective of the Account Manager... Manager , the core objective of the Account Manager is to support and develop lasting relationships with… more
- US Army Cyber Command (GA)
- …myriad of EEO problems; advising on high-level policies and practices including appeals and grievances , labor relations, position classification, training, and ... is located at Ft. Eisenhower, Georgia. Responsibilities Serves as the Equal Employment Manager for the US Army Cyber Command (ARCYBER) and Joint Force Headquarters -… more
- Fallon Health (Worcester, MA)
- …as quality improvement, credentialing, member rights, utilization management, including member appeals and grievances to support them in accreditation ... general direction from the Director of Quality, the Program Manager , Accreditation & Audit ensures that the health plan...that support the requirements. + Acts as the project manager for accreditation and audit activities + Ensures that… more
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