- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I... team to receive, investigate and resolve member and provider complaints and appeals ; escalates complex issues… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate… more
- Modivcare (Ridgeland, MS)
- …this opportunity may be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is ... role will work identify root causes of issues and provide real time solutions for members that have a...failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately… more
- Molina Healthcare (Tampa, FL)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals… 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 ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....the retrospective review process for authorizations and Member or Provider Appeals , including, but not limited to… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety...breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit… more
- Centene Corporation (Nashville, TN)
- …reporting and directories as well as claims payment resolution as it relates to provider set up. Provide support to external provider representatives to ... division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …healthcare? Bring your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the credentialed practitioner/ ... organizational provider networks ensuring our members receive the highest quality...Credentialing & Peer Review (CPR) Team, the Peer Review Specialist works closely with CPR's Director and Clinical Lead,… more
- State of Colorado (Pueblo, CO)
- Nurse Manager- Mid Level Provider - CMHHIP Nursing- Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5171266) Apply Nurse Manager- Mid ... Level Provider - CMHHIP Nursing- Pueblo Salary $8,788.00 - $12,302.00...behavioral health acute care facility that is intended to provide a safe, secure, and therapeutic setting for patients… more
- FLACRA (Clifton Springs, NY)
- …closely with Managed Care insurance providers to understand their policies, including grievances and appeals , and assist clients with advocacy as needed. ... Utilization Management Specialist FLACRA Clifton Springs, NY (Onsite) Full-Time $16.50...list. + Manage workflow efficiently with minimal interruptions. + Provide crisis management and referral services as necessary. +… more
- Commonwealth of Pennsylvania (PA)
- …Maintains inmate files for compliance with applicable laws and regulations and tracks appeals , misconducts, and grievances in electronic databases and paper case ... Records Specialist 1 Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5165293) Apply Records ...Your score is based on the detailed information you provide on your application and in response to the… more
- The Cigna Group (Salem, OR)
- …Complete onsite quality assessments + Respond to provider inquiries, concerns, complaints, appeals and grievances + Provide ongoing product education to ... in the USA** **Summary** This role delivers professional activities in the Provider Contracting job family. The position is responsible for dental provider… more
- Veterans Affairs, Veterans Health Administration (Seattle, WA)
- …Resolve simple, informal complaints of employees and refer others, such as formal grievances and appeals , to the supervisor or an appropriate management ... Summary This position serves as a Lead Personnel Security Specialist , and the work assigned is of a very...working in teams to accomplish tasks or projects, and provide or arrange for specific administrative or technical training… 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
- 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
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more
- State of Colorado (Denver, CO)
- …inmate hours and pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness, and creates real life ... work opportunities to prepare inmates for community reentry. Position may provide supervisory duties for additional inmate crews in the absence of another… 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… more
- State of Colorado (Denver, CO)
- …county public health, businesses, community organizations, and other stakeholders to provide high-quality early childhood and family support programs. The Accounting ... Reporting Standards (GASB), and state fiscal rules. This position will also provide accounting and/or financial advice to agency controllers and management. Major… more
- State of Colorado (Chaffee County, CO)
- …employee evaluations and plans; conducts performance evaluations, resolves informal grievances ; creates schedules, assigns tasks, inspects work; approves time, ... included as part of your application materials. Failure to provide a transcript or credential evaluation report may prevent...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
Related Job Searches:
Appeals,
Appeals Grievances,
Grievances,
Provider,
Specialist,
Specialist Appeals Grievances