- AmeriHealth Caritas (Philadelphia, PA)
- …**This position is hybrid in Philadelphia, PA** **Job Summary** The Appeals & Grievance Case Resolution Specialist is responsible for the full life cycle ... of assigned member and/or provider appeals and grievance cases. Working under general... cases. Working under general supervision, this role conducts case intake, investigation, and documentation to ensure accurate and… more
- CVS Health (Frankfort, KY)
- …with heart, each and every day. **Position Summary** Coordinate effective resolution of member and/or provider/practitioner appeals , complaints and grievances. ... Responsible for the day-to-day management of staff to ensure effective resolution of member or provider/practitioner appeals , complaints and grievances for all… more
- Henry Ford Health System (Troy, MI)
- …PRINCIPLE DUTIES AND RESPONSIBILITIES: + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines ... regulatory agencies, and providers the findings of their investigations and resolution . + Perform case pre-analysis; including procuring appropriate medical… more
- BayCare Health System (Clearwater, FL)
- …information, documentation, and medical records. Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring ... Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future occurrences....and contribute to the development of best practices for grievance and appeal resolution . + Adhere to… 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 for the ... Care's (LAC) membership. This position will ensure the effective investigation and resolution of clinical grievances, appeals , complaints, and complex issues in… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- CVS Health (Baton Rouge, LA)
- …**Position Summary** Must reside in Louisiana Responsible for intake, investigation and resolution of appeals , complaints and grievances scenarios for all ... of responses from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Identify trends and emerging issues and… more
- Humana (Raleigh, NC)
- …roles include an overview of coding practices and clinical documentation, dispute, grievance , and appeals processes, and outpatient services and equipment, ... of business, member population, or condition type. May also engage in dispute, grievance , and appeals reviews. May participate on project teams or organizational… more
- Humana (Baton Rouge, LA)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational… more
- City of New York (New York, NY)
- …but are not limited to the following: 1. Quickly identify key issues in a case and gain a rapid resolution with supervision and with latitude for independent ... with regard to various Tenant Grievances, Remaining Family Member Grievance Claims and Section 8 cases. This is done...and prepare memoranda. 5. Maintain computer records in the Case Management System and prepare memos and other documents… more
- University of Southern California (Los Angeles, CA)
- …and interviews faculty, respondents, and witnesses, and serves as the primary case processor and point of contact for all interested parties. Gathers, reviews, ... students complete assigned outcomes. Provides information as needed to the appeals coordinator. + . Communicates and provides information about the disciplinary… more
- University of Southern California (Los Angeles, CA)
- …interviews faculty, staff, respondents, and witnesses, and serves as the primary case processor and point of contact for all interested parties. Gathers, reviews, ... students complete assigned outcomes. Provides information as needed to the appeals coordinator. + Communicates and provides information about the disciplinary review… 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 ... Essential Accountabilities: Level I + Review / prep clinical case for clinical staff. + Navigates and utilizes corporate...to the roles/responsibilities of the position and participation in resolution of the same. + Active demonstration of broad… more