- Robert Half Accountemps (Long Beach, CA)
- Description We are seeking an experienced Medical Grievances and Appeals Specialist to join our dynamic team. The successful candidate will be responsible for ... and regulations. + Provide educational assistance to members regarding the grievance and appeals process. + Ensure record keeping system is maintained and… more
- LA Care Health Plan (Los Angeles, CA)
- …meet and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing ... assisting with the development of a successful and cohesive Appeals and Grievance unit, with a high...and or process improvement. Assist Supervisor to ensure that Specialist provide accurate, timely, and quality responses. Ensure that… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II...is primarily responsible for the overall coordination of the Appeals & Grievance (A&G) program for LA… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... 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
- UCLA Health (Los Angeles, CA)
- Description As the Appeal & Grievance Specialist , you will be responsible for: + Managing the intake and resolution of member and provider appeals and ... + Working closely with medical director and appeal & grievance team to ensure that all cases are handled...operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred * Experience in interpreting CMS… more
- LA Care Health Plan (Los Angeles, CA)
- …Summary The Supervisor, Authorization Technician supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the ... inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance /appeal requests, and prepares UM Activity and Weekly Compliance… more
- Elevance Health (Los Angeles, CA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... medical specialty required. **Preferred skills, capabilities, and experiences:** + Oncology specialist preferred + Internal medicine specialist preferred **For… more