- VNS Health (Manhattan, NY)
- …criteria. + Enters data and assists with compiling reports and analysis on the grievance and appeals process. + Participates in special projects and performs ... experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required +… more
- Commonwealth Care Alliance (Boston, MA)
- …to appeal and grievances. **What You'll Be Doing:** - Processing of Grievances & Appeals . - Responsible for the progress of grievance and appeal intervention and ... strict deadlines. - When necessary collaborate with care teams, clinical staff, family members, and other involved in providing...dental, reporting, and member services. - Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for...case reviews, and prepares final case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy… more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal ... and grievance process that meets state, federal, accreditation and other...of clinical nursing and medical practices, the Clinical Appeals Specialist will review… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II...and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary… more
- BayCare Health System (Clearwater, FL)
- …be working remotely? Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist -Health Plan **Location** Clearwater:Park Place | ... ensuring adherence to regulatory requirements. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring… more
- Elevance Health (Costa Mesa, CA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... shifts between 7am - 7pm CT (later shift hours preferred) The ** Clinical Operations Associate Medical Director** is responsible for supporting the medical management… more
- State of Colorado (Denver, CO)
- …Number CAA P/T Physician 10/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 10/28/2024 Closing Date 11/19/2024 ... on-call assessment, diagnosis, and treatment of inmates in one or more prison clinical settings. Physicians are responsible for, but not limited to, the following: +… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Authorization Technician Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... Summary The Supervisor, Authorization Technician supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the… more