- Harbor Health Services, Inc. (Mattapan, MA)
- …process improvement, communication to employees about QI efforts. Working with the Appeals and Grievances Specialist , maintains oversight of the Grievances and ... consistency of decisions. Supervisory responsibilities for UM RN, Quality Analyst, Appeals and Grievances Specialist . Requirements: Bachelor's Degree required,… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit...with unit projects and other duties related to the appeals , grievance , and/or reconsideration process. Communicates with… 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 Location: Los ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Molina Healthcare (San Antonio, TX)
- …claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, ... and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized… more
- Washington Headquarters Services (Alexandria, VA)
- …Incumbent typical work assignments may include the following: Serving as a senior specialist within the LMER division providing a full range of advisory services, ... guidance to managers and employees in the administration of the OSW/WHS Grievance System; counseling and advising managers and employees regarding their rights and… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …and Management Team + Legal Department: + Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare Advantage, and InterPlan Program) + ... your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the...Credentialing & Peer Review (CPR) Team, the Peer Review Specialist works closely with CPR's Director and Clinical Lead,… more
- Cedars-Sinai (CA)
- …CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc. + Remains updated ... **Job Description** The Managed Care Compliance Specialist is responsible for assisting with the implementation...ID** : 11981 **Working Title** : Managed Care Compliance Specialist - Managed Care **Department** : MNS Managed Care… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …referrals generated to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department ... Depending on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of the programs of Utilization… more
- Johns Hopkins University (Baltimore, MD)
- …actions and make sound recommendations to management. + Manage the grievance process, including fact finding, reviewing evidence, serving as hearing officer, ... as an advisor to employees and management on employee appeal and grievance issues. + Work in partnership with department management regarding appropriate… more
- State of Colorado (CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... of the department's action. For more information about the appeals process, the official appeal form, and how to...position, please direct your inquiries to our Employee Relations Specialist , Kristen Lange , at doc_###@state.co.us or call ###… more
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