- Brighton Health Plan Solutions, LLC (Westbury, NY)
- About The Role The Appeals Manager is responsible managing Appeal Supervisors and identifying opportunities for enhancements and changes to workflows to increase ... + Effectively manage Appeal Supervisors, providing full-time support to appeals , internal departments, vendors, and customers. + Demonstrate strong leadership… more
- Humana (Columbus, OH)
- …objectives and determines approach, resources, schedules and goals. The **Grievance and Appeals Manager ** is dedicated to delivering service and operational ... effectiveness of the Medicare and Medicaid G&A processes. The Grievance and Appeals Manager possesses strong leadership skills, in-depth knowledge of Medicare… more
- Banner Health (AZ)
- … Appeals department, programs and projects and assists the Grievance & Appeals Manager with day-to-day operations, ensuring production and quality standards ... by members and providers, pulls case files, meets with Grievance & Appeals Manager for further review and action which may include collaboration with others… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging… more
- LA Care Health Plan (Los Angeles, CA)
- …required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory timelines by ... obtaining clarification on initial responses. (25%) Under the supervision of the Appeals and Grievance Manager , assist with soliciting non-clinical information… more
- Internal Revenue Service (Memphis, TN)
- …us on the web at www.jobs.irs.gov Responsibilities WHAT IS THE INDEPENDENT OFFICE OF APPEALS (AP) DIVISION? A description of the business units can be found at: ... will be filled in the following specialty areas: Independent Office of Appeals , Case and Operations Support, Account and Processing Support Collection Area 1… more
- Trinity Health (Darby, PA)
- …processing and accuracy of patient stay claims data, denials management, and appeals . Assists RN Manager with establishing tools, processes, policies, procedure, ... **Employment Type:** Full time **Shift:** Day Shift **Description:** The Appeals and Utilization Management Coordinator under direction and in collaboration with the… more
- CVS Health (Harrisburg, PA)
- …make health care more personal, convenient and affordable. Position Summary The Associate Manager will assist in the hiring and managing of the Medicare Complaints ... Team staff. The Associate Manager must possess outstanding people skills, exercise good judgement, and contribute to a team environment. Ability to build positive… more
- Penske (Reading, PA)
- …This position will support the audit team in the management of the retrieval and analysis of data supporting Penske and affiliates operating tax audits. **Major ... Responsibilities:** + Manage multiple projects simultaneously involving multiple cross-functional teams. + Analyze and prioritize project activities to establish realistic deadlines. + Oversight of the collection, analysis, and the review of data and… more
- Fallon Health (Worcester, MA)
- **Overview** **The Member Appeals and Grievances Intake Administrator is working M - F 8 am to 5 pm in the office 5 days/week. We are looking for someone that is ... on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with… more
- Elevance Health (Palo Alto, CA)
- ** Manager II - Medical Management - RN - Grievances & Appeals ** **Location:** This position will work a hybrid model (remote and office). The ideal candidate ... the requisition. **Work Schedule:** M-F with rotation for Saturday. ** Manager II - Medical Management - RN - Grievances...II - Medical Management - RN - Grievances & Appeals ** is responsible to manage a team of clinicians… more
- CVS Health (Hartford, CT)
- …health care more personal, convenient and affordable. Position Summary: As a Senior Manager of Learning and Development, you are a strategic partner for the Aetna ... Medicare CTM, Grievances & Appeals business. You are a people leader with accountability...positive, measurable performance results for the Aetna Grievances & Appeals business unit. You will thrive in a rapidly… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is...assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and cohesive unit with… 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, 90017 ... to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible...culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the A&G Leadership in… more
- CareFirst (Owings Mills, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding ... adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all...And/or Compact State Licensure + CCM - Certified Case Manager + LNCC - Legal Nurse Consultant Certified **Experience**… more
- Office of the Secretary of the Interior (Arlington, VA)
- …to the Senior Executive Service (SES). Responsibilities The Director Office of Hearings and Appeals is located in the Office of the Secretary of Interior at the ... management and administrative responsibilities with respect to the hearings and appeals functions of the Department in accordance with existing policies,… more
- UNC Health Care (Chapel Hill, NC)
- …we serve. RN Utilization Manager position specifically for a Utilization Manager /Clinical Appeals Nurse. This person is based at the Hedrick building ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure… more
- Board of Veterans Appeals (Washington, DC)
- Summary The Board of Veterans' Appeals ' mission is to honor America's promise to its Veterans by timely resolving their appeals under the law. The Board of ... Veterans Affairs in deciding all questions of law and fact resolving Departmental appeals that affect the provision of benefits to Veterans, their dependents and… more
- TEKsystems (Plano, TX)
- Required: + 2+ years of Insurance follow-up, denials/ appeals experience (Medical A/R) + Hospital/facility collections experience Description: Responsible for A/R, ... correspondence, on underpaid, or non-paid balances. * Refers accounts to Supervisor/ Manager , or CBO Director for write-off consideration, agency or attorney… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This ... position reports to the Clinical Program Manager . This job description is not designed to cover...active and unrestricted licensure throughout employment. + Understanding of Appeals guidelines as applicable with URAC, NCQA, and ERISA.… more