- Fallon Health (Worcester, MA)
- …applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH ... **Overview** **The Member Appeals and Grievances Intake Administrator is working M... Appeals and Grievance process as outlined in the FH Member … more
- LA Care Health Plan (Los Angeles, CA)
- …is responsible for the centralized intake , logging and triage process for all member appeals and grievances. The Manager oversees the resolution of member ... the identification, documentation, reporting, investigation and resolution of all member appeals and grievances in a timely...on an annual basis, or as necessary, appeal and grievance policies and procedures, member correspondence, etc.,… more
- LA Care Health Plan (Los Angeles, CA)
- … Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals & Grievance Specialists by handling the administrative functions of the ... care management/continuity of care process including intake , logging, tracking and status follow-up. This position collects...staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in… more
- LA Care Health Plan (Los Angeles, CA)
- …grievances. Responsible for the development and maintenance of the appeal and grievance Policies and Procedures, workflows, Member correspondence, and training ... Scorecards meet regulatory requirements. Provide direction to staff for complex/sensitive member and provider inquiries, concerns, complaints, appeals , and… 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 ... is responsible for monitoring Appeal and Grievances Specialists, Lead Intake , and Senior Appeal and Grievances Specialists, performance against...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 ... ensuring strict adherence of the UM process from end to end including intake , medical policy criteria selection, application, and case closure. + Develop and review… more