- Molina Healthcare (New York, NY)
- …and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and ... organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving...monitoring and training of local plans' provider dispute and appeals units to ensure adherence with Medicare standards and… more
- VNS Health (Manhattan, NY)
- OverviewManages the day to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans product lines - Managed Long ... the day to day management of clinical appeals review processes within Appeals & Grievances Department. + Manages the intake, investigation and resolution of… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances , appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare ... each grievance or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with… more
- FlexStaff (New York, NY)
- …and support the organization's clinical review activities. + Support the needs for the appeals and grievances process. + Conduct charts review as necessary and ... **Req Number** 138917 FlexStaff is seeking a Regional Medical Director for our client, a non-profit healthcare organization providing home and community-based… more
- VNS Health (Manhattan, NY)
- …the administration of all BH QM/UM and performance improvement activities, encompassing grievances and appeals , and contributes to various other subcommittees ... maintain high-quality care standards. + Plans leadership and medical director meetings as stipulated by the State BH contract...4 years in a BH utilization and care management Director or above leadership role within a managed care… more
- City of New York (New York, NY)
- …a short window of time to issue a determination. The Associate will assist the Director of Appeals with handling visit restriction complaints and appeals ... Department of Correction" - Investigate serious incidents - Review grievances from people in custody and staff - Evaluate...with institutional security considerations to make recommendations to the Director of Appeals regarding the outcome of… more
- VNS Health (Manhattan, NY)
- …solutions for complex cases, reviews prior authorizations/denial of services, and grievances and appeals . Participates in weekly care management/UM rounds ... OverviewEmbark on a dynamic journey as the Medical Director at VNS Health Plans, where every day brings new challenges and opportunities to make a difference in… more
- MTA (New York, NY)
- …with union representatives to discuss contract grievance and employee discipline appeals ; perform analytical review of claims, grievances , and discipline ... - $100,000 HAY POINTS : 551 DEPT/DIV : Labor Relations SUPERVISOR : Assistant Director , Labor Relations LOCATION : 420 Lexington Ave, 11th Floor HOURS OF WORK :… more
- City of New York (New York, NY)
- …Contracting Officer (ACCO) and agency procurement staff in relation to procurement appeals and decision process, including draft opinions and the presentation of ... facts and decisions 8) assistance to the agency's Director of Labor Relations, Human Resources, and agency management on issues pertaining agency employees, locals… more
- City of New York (New York, NY)
- …of Correction ("DOC" or "the Department"); - Investigate serious incidents; - Review grievances from people in custody and staff; - Evaluate the performance of DOC; ... the jails. The Monitor will report to their assigned Director . Responsibilities include, but are not limited to: -...- Assisting in processing, evaluating and preparing responses to appeals from people in custody concerning the Minimum Standards… more