- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Sutter Health (Modesto, CA)
- …: **EDUCATION:** + _Equivalent experience will be accepted in lieu of the required degree or diploma._ + Bachelor's: degree in Business Administration, Nursing, ... Social Work, or other health care related field **TYPICAL EXPERIENCE:** + 2 years recent relevant experience **SKILLS AND KNOWLEDGE:** + Oral and written communication skills. must demonstrate writing skills including the ability to synthesize the facts of an… more
- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- Healthfirst (NY)
- …+ Bachelors degree + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization ... of services. The end to end process requires the Specialist to independently: + Research issues + Quality of...a framework that measures productivity and quality for each Specialist against expectations + Prepare cases for Medical Director… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances ... purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting...satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances , appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully ... or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers....Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …will consider collective experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, ... requests and electronic inquiries in order to identify and classify appeals and grievances as outlined in policies and procedures. Using internal systems,… 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 ... and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal… more
- CDPHP (Albany, NY)
- …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 ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- Generac Power Systems (Waukesha, WI)
- …energy technology solutions company, we continue to push new boundaries. **Job Summary:** The ** Appeals and Grievances Specialist ** is a critical team player ... under general supervision with some guidance from leadership and higher-level Appeals and Grievances Specialists. **Job Responsibilities:** Case Resolution +… more
- BayCare Health System (Clearwater, FL)
- …responsibility and clinical excellence. **Summary:** + Handles and processes customer appeals and grievances in accordance with established guidelines, company ... policies, and legal regulations. + Receive and document customer appeals and grievances via multiple channels (phone, email, online portals) in systems. + Ensure… more
- LA Care Health Plan (Los Angeles, CA)
- …due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals response letters ... Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the… more
- State of Colorado (Denver, CO)
- …to employee relations and providing analysis of potential risk (legal liability, appeals , grievances ) to the delegated staff authority for employee relations. ... DNR EDO Employee and Labor Relations Specialist II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4813937) Apply DNR EDO Employee and Labor… more
- Henry Ford Health System (Grand Blanc, MI)
- …bargaining agreement negotiations, mediation, and arbitration. + Experience in handling grievances / appeals required and prior involvement in arbitration. + Prior ... facilities and locations as needed. As a strategic partner, the Labor Relations Specialist provides HR and Labor Relations support to leaders and associates within… more
- University of Colorado (Boulder, CO)
- …with questions or concerns. Assists students with problem-solving and campus resources. Advances appeals or grievances to the Program Manager as appropriate. + ... **Computer Science Online Graduate Program Specialist / Senior Online Senior Graduate Program ... Specialist / Senior Online Senior Graduate Program Specialist ** **Requisition Number:** 61795 **Location:** Boulder Colorado **Employment Type:**… more
- State of Colorado (Pueblo, CO)
- Youth Services Specialist II - Pueblo Youth Service Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4812948) Apply Youth Services ... Specialist II - Pueblo Youth Service Center Salary $59,184.00...+ Ensures that youth are provided confidential access to grievances , medical assistance and mental health assistance as needed/requested… more
- Medical Mutual of Ohio (OH)
- …violations and complaints to the Medicare Advantage Sales Compliance area issued via Appeals and Grievances (A/G), the Complaint Tracking Module (CTM) and other ... their best possible health and quality of life. **Medicare Sales Operations Specialist ** Executes all end-to-end functions relating to the investigation of sales… more
- Washington Headquarters Services (Alexandria, VA)
- …. Manage cases related to adverse and disciplinary actions, dispute resolution, grievances , Merit Systems Protection Board (MSPB) appeals , and Office of ... procedural changes. Provide expert technical assistance and act as the agency representative in MSPB appeals , and may testify as technical expert in MSPB appeals… more
- Commonwealth of Pennsylvania (PA)
- …Maintains inmate files for compliance with applicable laws and regulations and tracks appeals , misconducts, and grievances in electronic databases and paper case ... Records Specialist 1 Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4800957) Apply Records Specialist 1 Salary $39,785.00 - $59,384.00… more