- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances ... net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G)...cross-functional departments to appropriately address and resolve member and provider grievances . + Responsible for timely daily… more
- Fallon Health (Worcester, MA)
- …Member Appeals & Grievances Department and Provider Appeals Department. This position will also provide administrative support to the departments. ... is divided equally between Member Appeals and Grievances Department and Provider Appeals ...calendar or at the direction of a supervisor or manager . **Qualifications** **Education** High School Diploma or GED required.… 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...or any combination of education and experience, which would provide an equivalent background. + Current active unrestricted RN… more
- Fallon Health (Worcester, MA)
- … and grievances addressed to the Member Appeals & Grievances Department. This position will also provide administrative support to the department. ... of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and… more
- Transdev (Dorchester, MA)
- …and governmental laws and regulations. + Manage the grievance process and provide comprehensive responses to complaints, grievances , and arbitrations that ... Transdev in Boston, MA is seeking a Labor Relations Manager for its Boston Public Schools transportation contract. The...policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal… 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:** Premier Administrative Solutions (PAS) is a Third-Party… more
- State of Colorado (Pueblo, CO)
- …detention, assessment, commitment and parole. DYS is the agency statutorily mandated to provide for the care and supervision of youth committed by the District Court ... This position ensures compliance with nondiscrimination policies and manages grievances related to discrimination. This position manages complaints, develops… 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 ... that accurate demographic, payment and fee schedules are loaded into the HF Provider System correctly. + Resolve configuration issues by identifying root causes in… 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,...clinical healthcare management and interdisciplinary team in order to provide care coordination support. + Manages non-clinical needs of… more
- Guardian Life (Phoenix, AZ)
- …for all assigned DSOs. Respond to provider inquiries, concerns, complaints, appeals and grievances within assigned timeframes. Collaborate across teams to ... to Dental Support Organization (DSO) partners. As a **Key DSO Dental Account Manager , Dental Support Organizations** , you will be responsible for growing the… 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
- 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 ... carriers for freight loss and damage and for failure to provide contracted services. Responsible for safeguarding, accomplishing, and issuing, accountable… more
- State of Colorado (Canon City, CO)
- …oversight which includes approving purchase requisitions, P-Card purchases, mid-level provider on-call remuneration, and operating supplies; + Provides nursing care ... reviews, and completing performance evaluations per CDOC regulations, and resolves complaints/ grievances at the informal level; + Ensures staff compliance with the… 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...clinical healthcare management and interdisciplinary team in order to provide care coordination support. + Manages non-clinical needs of… 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 ... 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
- LA Care Health Plan (Los Angeles, CA)
- …technical aspects of the retrospective review process for authorizations and Member or Provider Appeals , including, but not limited to computer data entry, ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and … 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...and Intranet Support Responsible for supporting the CDPS Communications Manager and Employee Engagement Team provide timely,… 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 ... eye exam; orders, distributes and makes minor adjustments to eyeglasses; + Provide general office support; answers phone, order office and medical supplies,… 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 ... policy clarification; makes on-site visits to program sites to provide face-to-face HR availability to employees in the work...Relations Specialist or Senior Manager of Employee Relations as required + Participates in… more