- Elevance Health (Los Angeles, CA)
- ** Manager I - Grievances & Appeals - Provider Disputes** **Location** : This position will work a hybrid model (in office 1-2 days per week). The ideal ... Maine, Missouri, Virginia, Indiana, Kentucky or New York. The ** Manager I - Grievances & Appeals...management oversight of receipt, investigation and processing associated with member/ provider grievances and appeals . **How… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN… more
- Elevance Health (Los Angeles, CA)
- …and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider , regulatory and third ... you will make an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory… more
- Elevance Health (Los Angeles, CA)
- … appeals departmental units to investigate, resolve, and respond to client/ provider grievances / appeals and ensure compliance with regulatory requirements. ... will live within 50 miles of one of our PulsePoint locations. The ** Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and… more
- Elevance Health (Cerritos, CA)
- …will make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or retrospective ... forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to...or any combination of education and experience, which would provide an equivalent background. Current active unrestricted RN license… more
- LA Care Health Plan (Los Angeles, CA)
- …experience in a patient care setting and/or combination in utilization management, appeals and grievances , delegation oversight, and/or CNA experience. At least ... Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's… more
- LA Care Health Plan (Los Angeles, CA)
- …care setting. Experience in health care auditing and monitoring (preferably in Appeals , Grievances , Quality Improvement, Utilization Management (UM) and so ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....Compliance unit, the Advisor also advises and supports the Manager , Director, and Chief Compliance Officer on other duties… more