- Sharp HealthCare (San Diego, CA)
- …Will Do** Responsible for the investigation, documentation and resolution of member appeals and grievances in compliance with State law, rules, and guidelines; ... Chief Medical Officer (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible… more
- Sharp HealthCare (San Diego, CA)
- …Do** Responsible for the investigation, documentation and resolution of Commercial member appeals and grievances in compliance with State law, rules, and guidelines; ... Chief Medical Officer (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible… more
- CVS Health (Sacramento, CA)
- …Summary** Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… 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
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- Elevance Health (Los Angeles, CA)
- **Title: Grievance/ Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law._ The **Grievance/ Appeals Analyst I** is an entry level position in...an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre… more
- Adecco US, Inc. (Ontario, CA)
- Adecco is assisting a local client recruiting for Clinical Appeals Representative opportunities in Ontario, CA (90% remote). This is an excellent opportunity to join ... an impact in the healthcare industry. If a Clinical Appeals Representative role sounds like something you would be...qualifications listed below, apply now! Responsibilities for a Clinical Appeals Representative include but are not limited to: +… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is...will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to… more
- Humana (Sacramento, CA)
- …The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately ... Medical Director's work includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above as well as… more
- Elevance Health (Walnut Creek, CA)
- **Behavioral Health Medical Director-Psychiatrist Appeals ** **Location:** California. This role enables associates to work virtually full-time, with the exception of ... a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any… more