- 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
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** **Position Summary:** Reporting to the Director of Appeals & Grievances , the Manager , Appeals & Grievances ... Plan level appeals and grievances within the Appeals & Grievances Department and delegated entities. The manager will work to ensures complaints and… more
- VNS Health (Manhattan, NY)
- …Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances . + Ensures the accuracy and integrity of data ... the day to day activities for staff handling of grievances and appeals for one of the...general direction. Compensation Range:$109,900.00 - $146,500.00 Annual What We Provide + Referral bonus opportunities + Generous paid time… more
- Elevance Health (Topeka, KS)
- …Capabilities and Experiences:** + Experience with Claims, Provider Payments, Provider Grievances , Appeals , administrative hearings, or other legal ... ** Provider 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 (Columbus, GA)
- …and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider , regulatory and third ... you will make an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory… 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 ... you will make an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory… more
- Elevance Health (Columbus, OH)
- … appeals departmental units to investigate, resolve, and respond to client/ provider grievances / appeals and ensure compliance with regulatory requirements. ... will live within 50 miles of one of our PulsePoint locations. The ** Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and… 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,...clinical information. + Identify opportunities for improvement and any provide support and assistance to G & A Analyst… 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, ... a quality manner. + May also be responsible to provide review and analysis of complex pre service and...and analysis of complex pre service and post service grievances and appeals requests from customer and… more
- Elevance Health (Los Angeles, CA)
- …will make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or retrospective ... forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to...or any combination of education and experience, which would provide an equivalent background. + Current active unrestricted RN… more
- Elevance Health (Rancho Cordova, CA)
- …will make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or retrospective ... forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to...or any combination of education and experience, which would provide an equivalent background. Current active unrestricted RN license… 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. + ... interprets policy provisions to determine the extent of company's liability and/or provider 's/beneficiaries entitlement. + Responds to appeals from CS Units, … more
- CareOregon (Portland, OR)
- …process to members, providers and CareOregon staff. + Perform intake of member and provider appeals & reconsiderations, gather data & documentation and prepare ... include customer service, claims processing, prior authorizations, formulary exceptions, appeals , grievances , and project participation. Essential Responsibilities… more
- State of Colorado (Trinidad, CO)
- CDOC / Corrections Case Manager I (Trinidad) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4658555) Apply CDOC / Corrections Case Manager ... that directly affect inmate classification, programming, or daily living which provide progressive opportunities for appropriate placement to include involvement in:… more
- Sacramento County (Sacramento, CA)
- …completed and certificate(s) received that are relevant to the Human Resources Manager I position. In your response, provide the degree(s)/certification ... License 11 List your employment experience that qualifies you for the Human Resources Manager I position. For all experience listed, provide the following: +… more
- Point32Health (MA)
- …and accreditation requirements for Care Management, Utilization Management, and / or Member Appeals and Grievances in a health plan setting preferred **Skill ... click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Program Manager is a Registered Nurse who performs program oversight activities… more
- State of Colorado (Denver County, CO)
- …constant process improvements. The manager works collaboratively with the Operations Manager to provide a seamless, transparent and effective process for the ... Manager , Customer Accounts and Variable Data Design -...state government, leading with responsiveness, integrity, and teamwork. We provide services to other government agencies and all Coloradans… more
- Fallon Health (Worcester, MA)
- …as quality improvement, credentialing, member rights, utilization management, including member appeals and grievances to support them in accreditation ... health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program… more
- Point32Health (Canton, MA)
- …action plans; and working collaboratively with other departments such as Appeals and Grievances , Pharmacy, Customer Relations, the Corporate Compliance ... Report actual and potential risks for non-compliance to senior manager and lead mitigation planning activities. Provide ...senior manager and lead mitigation planning activities. Provide guidance to senior manager and team… more
- Adecco US, Inc. (South Burlington, VT)
- …products. *Escalate client concerns and utilize core internal resources and systems for grievances and appeals . *Contribute to the performance of the service ... Reporting to the Director of Client Services and working cohesively with the Executive Manager , the core objective of the Account Manager is to support and… more