- Elevance Health (Topeka, KS)
- ** Member Grievance and Appeals - Business Change Advisor** **Location: Topeka KS, or Olathe, KS** This position will work a hybrid model (remote and ... of our Kansas Elevance Health PulsePoint locations. The ** Member Grievance and Appeals - Business Change Advisor** is responsible for representing the … more
- Elevance Health (Topeka, KS)
- ** Grievance / Appeals Analyst I** **Candidates must be located within 50 miles of Topeka, KS** The ** Grievance / Appeals Analyst I** is an entry level ... position in the Enterprise Grievance & Appeals Department that reviews, analyzes...processes non-complex pre service and post service grievances and appeals requests from customer types (ie member ,… more
- Elevance Health (Topeka, KS)
- …**How you will make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or ... **Nurse Appeals ** **Location:** This position will work a hybrid...timely to meet regulatory timeframes. + Documents and logs appeal/ grievance information on relevant tracking systems and mainframe systems.… more
- Elevance Health (Topeka, KS)
- …for incidents involving suspected abuse, neglect, or exploitation. + Makes a referral to Grievance and Appeals when a potential quality of care concern is ... one or more external client facing programs within a business unit. Program consultants typically support business ...of members. + Collaborates with Network Relations, Quality, and Grievance and Appeals on identifying and supporting… more
- Humana (Topeka, KS)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease... population, or condition type. May also engage in grievance and appeals reviews. Some medical directors… more
- Humana (Topeka, KS)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease... population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- Humana (Topeka, KS)
- …Behavioral Health, Long-Term Services and Supports, Health Information Technology, Enrollment, Member Services, Grievance and Appeals , Claims, Encounters, ... and growth of the Medicaid and Duals lines of business . This is a unique opportunity for a motivated...from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **Preferred Qualifications** + MBA… more
- Evolent Health (Topeka, KS)
- …Management Program and relevant Clinical Quality Improvement Programs + Participate in the Appeals and Grievance process, as necessary, to assure timely and ... reason why diversity and inclusion are core to our business . Join Evolent for the mission. Stay for the...Behavioral Health Field Medical Director will be a key member of the utilization management team. We can offer… more
- Humana (Topeka, KS)
- …assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team ... Director, depending on size of region or line of business . The Medical Director conducts Utilization Management of the...from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Scheduled Weekly Hours** 40… more
- Humana (Topeka, KS)
- …assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... to understand Humana processes with a focus on collaborative business relationships. The ideal candidate will have a high...to Public Health, Population Health, analytics, and use of business metrics. + Experience working with Case managers or… more
- Humana (Topeka, KS)
- …and/or the Project Management Institute + Knowledge of Medicare Advantage + Grievance and Appeals experience **Additional Information** Work Schedule: Monday - ... or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking… more