- Providence (Anaheim, CA)
- **Description** The Senior Manager Appeals and Grievances has direct responsibility for the design, implementation and ongoing operations of the Health Plan ... and ensures the efficient operational management of health plan appeals and grievances with emphasis on patient...caregiver dignity, outcome performance and continual improvement. The senior manager is a leader of PSJH mission, vision, values… more
- Point32Health (MA)
- …click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Senior Manager of Appeals and Grievances the Appeals and ... and provide leadership for the daily operations of the Appeals and Grievances department. The Supervisor represents...team of Analysts and Coordinators + Work with Senior Manager to ensure that employees have the requisite information… 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
- 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 (Meridian, ID)
- …& Appeals Coordinator** is responsible for investigating and reviewing customer grievances and appeals regarding provision of service and benefit coverage ... issues. Triages clinical and non-clinical inquiries, grievances and appeals , prepares case files for...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… 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 (Richmond, VA)
- …Department responsible to review, analyze and process pre service and post service grievances and appeals requests related to clinical and non clinical services, ... and analysis of complex pre service and post service grievances and appeals requests from customer and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Norfolk, VA)
- …Department responsible to review, analyze and process pre service and post service grievances and appeals requests related to clinical and non clinical services, ... and analysis of complex pre service and post service grievances and appeals requests from customer and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (KS)
- …Appeals Program Manager , Senior** will be responsible for managing Provider Grievances , Provider Appeals , and Provider State Fair Hearings for the Kansas ... **Grievance and Appeals Program Manager , Senior** **Location:** Kansas....of process redesign strongly preferred. + Experience with Member Grievances , Appeals , administrative hearings, or other legal… 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
- Elevance Health (Meridian, ID)
- …you will make an impact:** + Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues. + ... of previously processed claims. + Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either… 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
- The Cigna Group (Bloomfield, CT)
- …not limited to:** + Ability to differentiate different types of requests Appeals , Grievances , coverage determination and Organization Determinations in order to ... with appellants, leadership team, providers and the original case manager to resolve investigation issues and to ensure the...documents, correct appeal types, timeframes and what is being appeals + Assign priority and internal due date based… more
- Healthfirst (NY)
- …on clinical criteria for expedited cases + Helps standardize and optimize how Appeals and Grievances are routed + Determine best practices and strategically ... skill gaps in order to provide leadership and management to the Appeals & Grievances team + Identifies trends and recommends solutions for improvement. + Drives… 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
- State of Colorado (Grand Junction, CO)
- Licensing and Designation Manager - Remote Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4708760) Apply Licensing and Designation Manager ... on behalf of the BHA and receives and investigates grievances submitted to the BHA through complaints and critical...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Grand Junction, CO)
- Region IV Manager Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4690984) Apply Region IV Manager Salary $89,520.00 - $102,960.00 ... providing coaching and/or developing corrective action plans. + Resolves informal grievances , reviews formal grievances , and resolves customer and employee… 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
- State of Colorado (Denver, CO)
- …coordination with DVR finance and CDLE Procurement and Contracts unit; and responds to appeals and grievances at the supervisor level. This position assures that ... Business Enterprise Program Manager Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4710380) Apply Business Enterprise Program Manager … more
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