- Centene Corporation (New York, NY)
- … appeals and grievances from a clinical perspective. Ensure that the clinical Appeals and Grievance department processes all cases in accordance with ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- Centene Corporation (Sacramento, CA)
- …deployment. + Performs recruiting, hiring, promotion, and performance evaluation tasks and counsels non- clinical Grievance and Appeals staff. + Orients and ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Supervisor of Appeals & Grievances is accountable for the recruitment,… more
- LA Care Health Plan (Los Angeles, CA)
- …RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit. This position is responsible ... achieve regulatory standards. Acts as a back-up to the Supervisor in leading meetings and handling escalations as required....Registered Nurses Experience Required: At least 8 years of clinical appeals and grievances experience in a… 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 ... FH Appeals and Grievances Triage Administrator serves to administer the FH Appeals and Grievance process as outlined in the FH Member Handbook/Evidence of… more
- Corewell Health (Grand Rapids, MI)
- …+ Intermediate or advanced level using Microsoft Office Suite + Previous experience with grievance and appeals processes. About Corewell Health As a team member ... State and Federal decisions are properly implemented. Assist the Lead, Supervisor and/or Manager in coordinating activities and in the development/collection of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …referrals generated to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department ... Plan Essential Accountabilities: Level I + Review / prep clinical case for clinical staff. + Navigates...The care manager provides feedback to the non-care manager's supervisor , as needed, at the time of the annual… more