- VNS Health (Manhattan, NY)
- …the administration of all BH QM/UM and performance improvement activities, encompassing grievances and appeals , and contributes to various other subcommittees ... a commitment to delivering high-quality, personalized Behavioral Health services, placing member needs and recovery goals at the forefront of all initiatives.… more
- Commonwealth Care Alliance (Boston, MA)
- …to ensure work is completed timely and in compliance. + Leads and represents Member Appeals and Grievances -relatedexternal CMS audits, NCQA Standards, state ... to Us:** **Position Summary:** Reporting to the Director of Appeals & Grievances , the Manager ,...member appeals . + Work collaboratively within Appeals and Grievances with key internal partners… more
- Elevance Health (Columbus, OH)
- ** Manager I - Grievances & Appeals - Provider Disputes** **Location** : This position will work a hybrid model (in office 1-2 days per week). The ideal ... Maine, Missouri, Virginia, Indiana, Kentucky or New York. The ** Manager I - Grievances & Appeals...management oversight of receipt, investigation and processing associated with member /provider grievances and appeals . **How… more
- VNS Health (Manhattan, NY)
- … & Grievances Department. + Manages the intake, investigation and resolution of member grievances and appeals for one of the following VNS Health ... the day to day activities for staff handling of grievances and appeals for one of the...pharmacy benefit manager , to achieve resolution of appeals and grievances . + Ensures the accuracy… more
- Elevance Health (Columbus, GA)
- …and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member , provider, regulatory and third ... an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… 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 ... an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Columbus, OH)
- …50 miles of one of our PulsePoint locations. The ** Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals ... ** Manager II Grievance/ Appeals - Claims Support**...departmental units to investigate, resolve, and respond to client/provider grievances / appeals and ensure compliance with regulatory requirements.… more
- Elevance Health (Richmond, VA)
- …analyzing and processing non-complex and some complex pre service and post service grievances and appeals requests in the Enterprise Grievance & Appeals ... + The analyst may serve as a liaison between grievances & appeals and /or medical management,...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Bon Air, VA)
- …Department responsible to review, analyze and process pre service and post service grievances and appeals requests related to clinical and non clinical services, ... and analysis of complex pre service and post service grievances and appeals requests from customer and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Olathe, KS)
- …an equivalent background. **Preferred Skills, Capabilities and Experiences:** + Experience with Member Grievances , Appeals , administrative hearings, or other ... ** Member Grievance and Appeals - Business Change...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Los Angeles, CA)
- …**How you will make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or ... forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Rancho Cordova, CA)
- …**How you will make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or ... forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Indianapolis, IN)
- …you will make an impact:** + Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues. + ... of previously processed claims. + Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either… more
- CareOregon (Portland, OR)
- …customer service, claims processing, prior authorizations, formulary exceptions, appeals , grievances , and project participation. Essential Responsibilities ... formulary exception decisions. + Perform prior authorization reviews with pharmacist oversight. Appeals and Grievances + Explain pharmacy appeal and … more
- Randstad US (Pleasanton, CA)
- …peers in self-managed teams to meet deadlines. Preferred Qualifications: Knowledge of member grievance and appeals process preferred., Knowledge of federal and ... case manager . + pleasanton , california + posted august...and grievance handling, compliance, documentation and enhancement of the member experience. + Partner with and outreach to internal… more
- Sacramento County (Sacramento, CA)
- Human Resources Manager I Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/3385544) Apply Human Resources Manager I Salary $137,265.12 - ... at 5:00 pm on: 9/20/24, 10/18/24 (final) Positions assigned to Human Resources Manager I, under direction, manage a human resources program that may include… more
- Point32Health (Canton, MA)
- …action plans; and working collaboratively with other departments such as Appeals and Grievances , Pharmacy, Customer Relations, the Corporate Compliance ... at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Program Manager is responsible for key departmental functions related to the… more
- Elevance Health (Kansas City, KS)
- …Services, Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + ... supported, facilitates the Person Centered Planning process that documents the member 's preferences, needs and self-identified goals, including but not limited to… more
- Fallon Health (Worcester, MA)
- …such as quality improvement, credentialing, member rights, utilization management, including member appeals and grievances to support them in ... continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our...general direction from the Director of Quality, the Program Manager , Accreditation & Audit ensures that the health plan… more
- Point32Health (MA)
- …compliance and accreditation requirements for Care Management, Utilization Management, and / or Member Appeals and Grievances in a health plan setting ... click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Program Manager is a Registered Nurse who performs program oversight activities… more
