- Elevance Health (Topeka, KS)
- ** Member Grievance and Appeals - Business Change Advisor** **Location: Topeka KS, or Olathe, KS** This position will work a hybrid model (remote and ... of our Kansas Elevance Health PulsePoint locations. The ** Member Grievance and Appeals - Business Change Advisor** is responsible for representing the … more
- Elevance Health (Topeka, KS)
- ** Grievance / Appeals Analyst I** **Associate Referral Bonus:** **$250** **Location:** This position will work a hybrid model (remote and office). Candidates must ... Olathe, KS, Topeka, KS, or Overland Park, KS. The ** Grievance / Appeals Analyst I** is an entry level...processes non-complex pre service and post service grievances and appeals requests from customer types (ie member ,… more
- Humana (Topeka, KS)
- …on business needs. Voluntary overtime may also be available. + **Grievances and Appeals (G&A) has an impact to our business and because of the complexities ... for further review. + They are expected to resolve member and practitioner issues to the best of their...18 months.** **Required Qualifications** + Minimum 1 year of Grievance & Appeals and/or relevant customer service… more
- Elevance Health (Topeka, KS)
- …**How you will make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or ... **Nurse Appeals ** **Location:** This position will work a hybrid...timely to meet regulatory timeframes. + Documents and logs appeal/ grievance information on relevant tracking systems and mainframe systems.… more
- Elevance Health (Topeka, KS)
- …for incidents involving suspected abuse, neglect, or exploitation. + Makes a referral to Grievance and Appeals when a potential quality of care concern is ... one or more external client facing programs within a business unit. Program consultants typically support business ...of members. + Collaborates with Network Relations, Quality, and Grievance and Appeals on identifying and supporting… more
- Humana (Topeka, KS)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease... population, or condition type. May also engage in grievance and appeals reviews. Some medical directors… more
- Highmark Health (Topeka, KS)
- …and member requests, received from Medical Management & Policy (MM&P) and Member Grievance Departments. * Responsible for management of Peer to Peer ... and assignment of all incoming physician reviewer referrals and appeals to ensure that NCQA, URAC, CMS, DOH, DOL...behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of… more
- Evolent Health (Topeka, KS)
- …Management Program and relevant Clinical Quality Improvement Programs + Participate in the Appeals and Grievance process, as necessary, to assure timely and ... reason why diversity and inclusion are core to our business . Join Evolent for the mission. Stay for the...Behavioral Health Field Medical Director will be a key member of the utilization management team. We can offer… more
- Humana (Topeka, KS)
- …assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team ... Director, depending on size of region or line of business . The Medical Director conducts Utilization Management of the...from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Scheduled Weekly Hours** 40… more
- Humana (Topeka, KS)
- …assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... to understand Humana processes with a focus on collaborative business relationships. The ideal candidate will have a high...to Public Health, Population Health, analytics, and use of business metrics. + Experience working with Case managers or… more
- Humana (Topeka, KS)
- …and/or the Project Management Institute + Knowledge of Medicare Advantage + Grievance and Appeals experience **Additional Information** Work Schedule: Monday - ... or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking… more