- Elevance Health (Los Angeles, CA)
- ** Manager I - Grievances & Appeals - Member Appeals ** **Location** : This position will work a hybrid model (in office 1-2 days per week). The ideal ... within 50 miles of one of our Elevance Health PulsePoint locations in California. The ** Manager I - Grievances & Appeals ** is responsible for management… 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 ... an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Los Angeles, CA)
- …**How you will make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or ... forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Los Angeles, CA)
- …entities. + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non ... **Nurse Appeals (Quality) - California candidates only** **Location: This...impact:** Responsible for investigating and processing quality of care grievances from members and providers. **Primary duties may include,… 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 ... for the Regulatory Compliance unit, the Advisor also advises and supports the Manager , Director, and Chief Compliance Officer on other duties as assigned to support… more