- Providence (Anaheim, CA)
- **Description** The Senior Manager Appeals and Grievances has direct responsibility for the design, implementation and ongoing operations of the Health ... and ensures the efficient operational management of health plan appeals and grievances with emphasis on patient...and caregiver dignity, outcome performance and continual improvement. The senior manager is a leader of PSJH… more
- Point32Health (MA)
- …here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Senior Manager of Appeals and Grievances the Appeals and ... and provide leadership for the daily operations of the Appeals and Grievances department. The Supervisor represents...assigned team of Analysts and Coordinators + Work with Senior Manager to ensure that employees have… more
- Elevance Health (KS)
- …PulsePoint locations. The **Grievance and Appeals Program Manager , Senior ** will be responsible for managing Provider Grievances , Provider Appeals ... **Grievance and Appeals Program Manager , Senior **...of process redesign strongly preferred. + Experience with Member Grievances , Appeals , administrative hearings, or other legal… more
- Elevance Health (Richmond, VA)
- …+ HS diploma or equivalent + Minimum of 3 years of Grievance & Appeals Senior analyst experience; or any combination of education and experience which ... review, analyze and process pre service and post service grievances and appeals requests related to clinical...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Norfolk, VA)
- …school diploma or GED equivalent and a minimum of 3 years of Grievance & Appeals Senior analyst experience; or any combination of education and experience which ... review, analyze and process pre service and post service grievances and appeals requests related to clinical...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** The Senior Product Manager , Claims will define the product strategy, vision, and value ... for members, improving payment integrity, and optimizing the experience of denials, appeals , and grievances . The ideal candidate outlines the strategic vision… more
- Medical Mutual of Ohio (OH)
- …new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances , and Medicare marketing material requirements. . Assists ... new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances , and Medicare marketing material requirements. . Assists… more
- Internal Revenue Service (San Francisco, CA)
- …CAREERS? Visit us on the web at www.jobs.irs.gov Responsibilities WHAT IS THE AP- APPEALS DIVISION? A description of the business units can be found at: ... https://www.jobs.irs.gov/about/who/business-divisions The IRS Independent Office of Appeals has career opportunities for you! Vacancies will be filled in the… more
- Elevance Health (Colorado Springs, CO)
- …(QOC) investigations in coordination with BH Medical Director, Member Safety and Grievances & Appeals leadership and team members. **Minimum Requirements:** + ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Office of the Secretary of Labor (Washington, DC)
- …of Labor (DOL), ensuring timely, efficient, fair and impartial adjudication of appeals of workers' claims. The position supports DOL's three Appellate Adjudicatory ... Board (BRB), the Administrative Review Board (ARB), and the Employees' Compensation Appeals Board (ECAB). This position reports to the BRB's Chair/Chief Judge.… more
- Fallon Health (Worcester, MA)
- …as quality improvement, credentialing, member rights, utilization management, including member appeals and grievances to support them in accreditation ... general direction from the Director of Quality, the Program Manager , Accreditation & Audit ensures that the health plan...regulatory environment to promote awareness with other directors and senior leaders of the health plan the impact of… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …general knowledge of Federal personnel administration policies and practices including appeals and grievances , Labor Relations, Employee Relations, Position ... the Office of the Director and assist the EEO Manager in planning, development, implementation, evaluation, and monitoring the...new or revised policies and procedures in EEO. Brief senior leaders, managers, and supervisors on EEO mission, goals,… more
- LA Care Health Plan (Los Angeles, CA)
- …care setting. Experience in health care auditing and monitoring (preferably in Appeals , Grievances , Quality Improvement, Utilization Management (UM) and so ... for the Regulatory Compliance unit, the Advisor also advises and supports the Manager , Director, and Chief Compliance Officer on other duties as assigned to support… more
- 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 ... leadership and medical director meetings as stipulated by the State BH contract manager . Serves as the principal behavioral health/social care expert and liaison for… more