- VNS Health (Manhattan, NY)
- … review processes within Appeals & Grievances Department. + Manages the intake , investigation and resolution of member grievances and appeals for ... monitors and audits subcontractors who have delegated responsibility for managing grievance and appeals on behalf of the plan to ensure operational and… more
- CVS Health (Columbus, OH)
- …-Identify and research all components within member or provider/practitioner appeals , complaints and grievance for all products and services. -Triage ... for coordination of all components of appeals , complaints and grievance including final communication to member /provider for final resolution and… more
- BayCare Health System (Clearwater, FL)
- …disagreements, and ensuring adherence to regulatory requirements. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track ... **Education:** + Associate's degree - related field **Experience:** + 3 years Appeals and Grievance . **Facility:** BayCare Health System **Location:** **Park… more
- LA Care Health Plan (Los Angeles, CA)
- …grievances. Responsible for the development and maintenance of the appeal and grievance Policies and Procedures, workflows, Member correspondence, and training ... Scorecards meet regulatory requirements. Provide direction to staff for complex/sensitive member and provider inquiries, concerns, complaints, appeals , and… more
- Insight Global (Los Angeles, CA)
- …all appeals and grievances, developing and maintaining the appeal and grievance policies and procedures, workflows, member correspondence, and training as ... Job Description The Supervisor of the Customer Solution Center Appeals and Grievances is responsible for directly supervising and supporting the team that handles… more
- LA Care Health Plan (Los Angeles, CA)
- …area within the department. Investigation, and resolution of clinical member complaints (grievances/ appeals ) utilizing all regulatory requirements. ... Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job...Specialist Registered Nurse (RN) II provides direct assistance to member 's with health care access or benefit coordination issues,… more
- CareOregon (Portland, OR)
- …and grievances provisions and process to members, providers and CareOregon staff. + Perform intake of member and provider appeals & reconsiderations, gather ... appeals and notify members and providers of outcome. + Assist the Appeals & Grievance Coordinators, Pharmacists, Medical Directors and Quality Improvement… more