- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN...culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the A&G Leadership in… 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 (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 (Los Angeles, CA)
- …**Preferred Skills, Capabilities, and Experiences:** + Strongly preferred: Experience in handling grievances and appeals . For candidates working in person or ... the United States when conducting utilization review or an appeals consideration and cannot be located on a US...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- LA Care Health Plan (Los Angeles, CA)
- …review of the configuration of health services/population health as well as appeals and grievances systems, applications, etc. Equivalency: Completion of the ... Summary The Supervisor, Quality Configuration Assurance works with the Manager , Systems Configuration Performance Improvement and Director, Quality Configuration to… 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