- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances ... support the safety net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General Operations (Clinical) is responsible… more
- Fallon Health (Worcester, MA)
- …other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH ... standards. The Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals &… more
- Elevance Health (FL)
- …providers, and regulatory entities, and serves as a subject matter expert for appeals , grievances , and quality of care issues. + Key responsibilities: serves ... **Nurse Appeals - Litigation & Legal Support** **In Office...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances...clerical/administrative responsibilities at the discretion of the Director or Manager . * Providing administrative assistance in support of the… more
- Transdev (Dorchester, MA)
- …of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal requirements and ... Overview: Transdev in Boston, MA is seeking a Labor Relations Manager for its Boston Public Schools transportation contract. The Labor Relations Manager provides… 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
- CHS (Clearwater, FL)
- …client trust. * Investigates and participates in formal responses relating to complaints, grievances and appeals received by or applicable to PAS. Participates ... **Overview** **Claims Manager ** **Servicing** **Health Insurance Policies or Benefits** **Summary:**...stated coverage. Join Premier Administrative Solutions as a Claims Manager and lead our Claims Department in delivering exceptional… more
- Elevance Health (Plainfield, IN)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + BA/BS degree ... **LTSS Service Coordinator (Case Manager )** **Location:** Seeking candidates to work in Daviess,...and direct, hands-on engagement. The **LTSS Service Coordinator (Case Manager )** is responsible for conducting service coordination functions for… more
- Air National Guard Units (Duluth, MN)
- …14284 Responsibilities Major Duties: This is not an all-inclusive list A TRAFFIC MANAGER (T32), GS, 2130, 9, Incumbent serves as the technical transportation advisor ... Selects or contributes significantly to the selection of subordinates. Hears employee grievances and works with union representatives, as necessary. Plans for and… more
- Sanford Health (Rapid City, SD)
- …and interaction with payers. Additional duties include management of medical denials, appeals , and grievances . Understand and provide insight into evaluating ... Details** Join our team as a Utilization Review and Case Management Manager and lead a high-impact, data-driven program that elevates patient outcomes while… more
- Elevance Health (OH)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... **LTSS Service Coordinator (Case Manager )** **Candidates should live in one of the...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… 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 ... daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints/ grievances at the informal level, responsibility for scheduling and… more
- Guardian Life (Phoenix, AZ)
- …contact for all assigned DSOs. Respond to provider inquiries, concerns, complaints, appeals and grievances within assigned timeframes. Collaborate across teams ... to Dental Support Organization (DSO) partners. As a **Key DSO Dental Account Manager , Dental Support Organizations** , you will be responsible for growing the… more
- Healthfirst (Enfield, NY)
- …Claims departments. Clearly communicate resolutions and progress to the Providers. + Assist Appeals and Grievances (A&G) department by acting as liaison between ... Providers and A&G department to achieve favorable outcomes of member related issues, complaints, balance billing and other issues. + Ensure that all Providers inquiries received via email and phone call are addressed efficiently and effectively within required… more
- State of Colorado (Canon City, CO)
- …reviews, and completing performance evaluations per CDOC regulations, and resolves complaints/ grievances at the informal level; + Ensures staff compliance with the ... daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints/ grievances at the informal level, responsibility for scheduling and… 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
- 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 HR guidance to COPS managers, supervisors, and… more
- State of Colorado (Denver, CO)
- …projects, reviewing plans and coordinating with contractors, Physical Plant Manager , Custody/Control and other facility supervisors to ensure efficiency, security ... Orders and ensuring completion of mandatory annual training. + Resolving informal grievances This position may participate in the Duty Officer rotation; is subject… more
- State of Colorado (Chaffee County, CO)
- …orders will be handled in conjunction with the Clinical Services Support Services Manager ; + Procure, track and record inmate health record movement arriving in and ... answers phone, order office and medical supplies, distribute and track medical grievances , arrange for repair of office equipment, monthly reporting, sort and… more
- Volunteers of America Los Angeles (Los Angeles, CA)
- …and resolution of facts and issues in matters affecting disciplinary actions, grievances , appeals , and complaints, refers complex matters to HR Employee ... Relations Specialist or Senior Manager of Employee Relations as required + Participates in...with 20+% dedicated time committed to handling employee complaints, grievances , interactive processes, and disciplinary actions. + Familiarity with… more
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