- 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 ... clarification on initial responses. (25%) Under the supervision of the Appeals and Grievance Manager , assist with soliciting non-clinical information from… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH… 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...5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health… more
- LA Care Health Plan (Los Angeles, CA)
- …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and cohesive unit with...the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB… 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
- CareOregon (Portland, OR)
- Job Title Quality Assurance and Compliance Manager Exemption Status Exempt Department Transportation Manager Title Director of Transportation Direct Reports ... Quality Assurance and Compliance Specialist, Grievance System Specialist Requisition # 24307 Pay & Benefits...covered under Medicaid and Medicare lines of business, including appeals and grievances, as well as data reporting. This… more
- State of Colorado (CO)
- CDOC / Parole Release Case Manager Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4549914) Apply CDOC / Parole Release Case Manager ... minimum. Hiring Pay Rate Salary Note: The entire range for the Corrections Case Manager I position is listed; however, the CDOC minimum for this position is… more
- HCA Healthcare (Asheville, NC)
- …for over sight of the Contract Liaison, HIMS Clerk and Service Delivery, Appeals and Grievance (SDAG) Coordinator. Essential Accountabilities: + Develops and ... family! Jump-start your career as a Quality and Compliance Manager for the PACE Program today with CarePartners. **Benefits**...Come join our team as a Quality and Compliance Manager PACE Program. We care for our community! Just… more
- Veterans Benefits Administration (Seatac, WA)
- …The Supervisory Veterans Service Representative (Assistant Decision Review Operations Center Manager ) works in the Decision Review Operations Center of the Seattle ... Supervisory Veterans Service Representative (Assistant Decision Review Operations Center Manager ) shares in the responsibility of managing Decision Review Operations… more
- LA Care Health Plan (Los Angeles, CA)
- …following 3 health plan functions: Call Center Operations, Enrollment Services Operations, Appeals & Grievance Operations For Advanced Analytics Lab: Preferred: ... Manager , Business Insights Job Category: Management/Executive Department: Advanced...net required to achieve that purpose. Job Summary The Manager of Business Insights for Advanced Analytics Lab (AAL)… more
- CVS Health (Lansing, MI)
- …obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. + Coordinates provider status information ... with member services and other internal departments. + Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions. +… more
- CVS Health (Austin, TX)
- …obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc.- Coordinates provider status information ... with member services and other internal departments.- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.-… more
- Spokane County (Spokane, WA)
- …to improve performance as needed. + Oversees administrative management of the Grievance System, to include grievances, appeals and fair hearings. Identifies ... eligible individuals. As directed by the Integrated Behavioral Healthcare Manager , the incumbent supervises Integrated Care Coordinators, Integrated Behavioral… more
- State of Colorado (Canon City, CO)
- …at the informal level; + Ensures staff compliance with the offender grievance process, offender co-pay, electronic data entry, and information systems requirements; ... establish an eligible list for referral to the hiring manager for final consideration. Be sure the "Work Experience"...Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel… more
- State of Colorado (CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... establish an eligible list for referral to the hiring manager for final consideration. Be sure the "Work Experience"...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Johns Hopkins University (Baltimore, MD)
- …administration and analysis, benefits administration, employee relations (including grievance resolution, disciplinary action, reductions in force, termination), ... + Provide guidance and make recommendations to the division and hiring manager on appropriate starting salaries and promotional salaries for faculty and staff… more
- Robert Half Finance & Accounting (Washington, DC)
- …evaluations, from organizational competencies to feedback, and day to day manager /supervisee utilization, guiding the incorporation of the process into HRIS system, ... and serve as back up to People Department Senior Manager on bi-weekly payroll run as needed + Own...collective bargaining unit, including direct involvement in any formal grievance processes according to the terms of the collective… more
- Montana State University (Bozeman, MT)
- …indexes, including salaries, operations, and grants. Serve as an account manager for purchasing card transactions, including compilation of monthly reports. Serve ... audits, transfer coursework and substitutions of courses; serve as exceptions manager ; register students in restricted-entry courses; Analyze and process requests… more
- Veterans Benefits Administration (Houston, TX)
- Summary The Supervisory Veterans Service Representative (Assistant Veterans Service Center Manager ) shares in the responsibility of managing Veterans Service Center ... inquiries for approval. Serves as technical advisor to the Service Center Manager and/or Regional Office Director for the administration of Compensation and Pension… more
- Prime Care Coordination (Webster, NY)
- …in at least one of the following areas: call center operations, MLTC, grievance and appeals , and/or authorizations. The listed salary range represents the ... and transfer/refer callers to alternate sources when appropriate (such as care manager , enrollment, etc). + Create and process service authorizations, ensuring that… more