- Point32Health (VA)
- …click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member ... regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health.… more
- VNS Health (Manhattan, NY)
- …criteria. + Enters data and assists with compiling reports and analysis on the grievance and appeals process. For Fair Hearings: + Supports Grievance ... underlying issues, analyzes and solves problems. Consults with the member , family, providers and health plan departments as necessary....Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents… more
- Elevance Health (Indianapolis, IN)
- **Title: Grievance / Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The ** Grievance / Appeals Analyst I** is an entry level...processes non-complex pre service and post service grievances and appeals requests from customer types (ie member ,… more
- Elevance Health (Richmond, VA)
- **Title: Grievance / Appeals Analyst Lead** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... a California PulsePoint location. The ** Grievance / Appeals Analyst Lead** will be responsible for...vary depending on the above factors as well as market/ business considerations. No amount is considered to be wages… more
- Elevance Health (Norfolk, VA)
- ** Grievance / Appeals Analyst Lead** **Candidates must be located within 50 miles of Atlanta, GA, Miami, FL, Mason, OH, Norfolk, VA, Tampa, FL, or Topeka, KS** The ... ** Grievance / Appeals Analyst Lead** is responsible for leading...They are how we achieve our strategy, power our business outcomes and drive our shared success - for… more
- Elevance Health (Atlanta, GA)
- …quality, and regulatory compliance.** PRIMARY DUTIES: + Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings. + Leads grievance ... like Power Pivot. + Develops predictive models to forecast business needs and meet key objectives. + Serves as...thresholds within budgetary guidelines. + Monitors trends and analyzes grievance and appeals data to identify and… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …G&A Coordinator lends their support in processing member -related grievances and appeals across CPHL's various lines of business . Process includes gathering, ... Grievance and Appeals Coordinator 75 Vanderbilt...PRIMARY RESPONSIBILITIES: + Logs and tracks verbal or written member grievances and appeals . + Conducts relevant… more
- Baylor Scott & White Health (Temple, TX)
- …performs reviews, within operational aspects, of the member and provider complaints, appeals and grievance cases for products for all lines of business ... Appeals and Grievance Specialist...authorized representatives concerns and disputes for all lines of business . Contacts members and providers to gather information and… more
- Elevance Health (KS)
- ** Grievance and Appeals Program Manager, Senior** **Location:** Kansas. This position will work a hybrid model (remote and office). The ideal candidate will live ... 50 miles of one of our Kansas Elevance Health PulsePoint locations. The ** Grievance and Appeals Program Manager, Senior** will be responsible for managing… more
- Humana (Columbus, OH)
- …resources, schedules and goals. The Manager leads a team of Grievances & Appeals associates responsible for handling member inquiries and resolving member ... Degree - Preferred + More than 3 years of grievance and appeals experience + Strong knowledge...Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. . Work from a… more
- Health First (Rockledge, FL)
- …(Health Insurance)* **Organization:** **HF Administrative Plan Inc* **Title:** *HFHP Appeal / Grievance Coordinator - Member Appeals Grievances* **Location:** ... Quality, Memorable Patient/Customer Experiences, and Financial Stewardship by resolving member complaints in a timely, professional and compliant manner. Success… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Tuesday, November 5, 2024 Centers Plan for Healthy Living's goal ... the guidance and plans they need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial… more
- CVS Health (Richmond, VA)
- …from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Identify trends and emerging issues and report ... -Identify and research all components within member or provider/practitioner appeals , complaints and grievance for all products and services. -Triage… more
- Elevance Health (Walnut Creek, CA)
- …duties may include, but are not limited to: + Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings. + Leads grievance and ... **Manager II Grievance / Appeals (RN)-California** **Location** : This position...and interpretation of claims, provider contracts and data, eligibility, member contracts, benefits, clinical decisions, pharmacy on pre-service and… more
- CVS Health (Sacramento, CA)
- …-Identify and research all components within member or provider/practitioner appeals , complaints and grievance for all products and services. **Required ... carrying a modified case load including but not limited to:-Research incoming electronic appeals , complaints and grievance to identify if appropriate for unit… more
- CVS Health (Richmond, VA)
- …multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Responsible for day-to-day implementation of Aetna's ... -Identify and research all components within member or provider/practitioner appeals , complaints and grievance for all products and services. **Required… more
- LA Care Health Plan (Los Angeles, CA)
- …cases that require immediate clinical quality of care, initial coding of member grievance and evaluation and/or require immediate pre-service authorization ... is primarily responsible for the overall coordination of the Appeals & Grievance (A&G) program for LA...clinical review of medical records related to grievances and appeals . Responsible for handling member and provider… more
- CareFirst (Baltimore, MD)
- …membership, and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an experienced people ... field, Legal Nurse Consultant, Utilization Management, and Government Program experience with Appeals and Grievance , Experience with MCG, InterQual, NCD and… more
- CareFirst (Baltimore, MD)
- …3 years supervisory experience Utilization Management, and Government Program experience with Appeals and Grievance , Experience with MCG, InterQual, NCD and ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate...on behalf of members for Government Programs lines of business . Develops, evaluates and oversees the implementation of policies… more
- BayCare Health System (Clearwater, FL)
- …ensuring adherence to regulatory requirements. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring ... be working remotely? Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist-Health Plan **Location** Clearwater:Park Place | Business… more