- Elevance Health (Los Angeles, CA)
- ** Manager II - Grievances & Appeals -** ** Provider Disputes** **Location:** This position will work a hybrid model (in office 1-2 days per week). The ... Open Access Pulse Points listed in this requisition. **The Manager II - Grievances & Appeals...a resource for complex issues and interpretation of claims, provider contracts and data, eligibility, member contracts, benefits, clinical… more
- 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 ... 50 miles of one of our Open Access Pulse Points listed in this requisition. **The Manager I - Grievances & Appeals ** will be responsible for management… 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)
- …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… more
- LA Care Health Plan (Los Angeles, CA)
- …Management, Risk Adjustment, Products, Customer Solution Center (CSC), reporting and Analytics, Appeals and Grievances and the provider network. Manage ... Clinical Quality Program Manager III Job Category: Clinical Department: Quality Improvement...public agency created by the state of California to provide health coverage to low-income Los Angeles County residents.… more
- Volunteers of America Los Angeles (Los Angeles, CA)
- …and resolution of facts and issues in matters affecting disciplinary actions, grievances , appeals , and complaints, refers complex matters to HR Employee ... policy clarification; makes on-site visits to program sites to provide face-to-face HR availability to employees in the work...Relations Specialist or Senior Manager of Employee Relations as required + Participates in… 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
- Elevance Health (Los Angeles, CA)
- …**Preferred Skills, Capabilities, and Experiences:** + Strongly preferred: Experience in handling grievances and appeals . For candidates working in person or ... programs to improve quality, cost, and outcomes. + May provide clinical consultation and serve as clinical/strategic advisor to...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- LA Care Health Plan (Los Angeles, CA)
- …review of the configuration of health services/population health as well as appeals and grievances systems, applications, etc. Equivalency: Completion of the ... 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