- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Supervisor, Customer Solution Center Appeals & Grievances is responsible for direct supervision and support of the… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- Magellan Health Services (San Diego, CA)
- Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests. In some cases may be ... medical necessity reviews. + Enters all data related to appeals and case reviews into a database. + Prepares...into a database. + Prepares and presents information on appeals to panels second-level multi-disciplinary committee. + Participates in… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... 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
- Elevance Health (Woodland Hills, CA)
- **Title: Grievance/ Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of ... our PulsePoint locations. 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
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... 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
- Elevance Health (Costa Mesa, CA)
- **Nurse Appeals - Licensed Nurse** **Location:** *The ideal candidate must reside in the state of California and live within 50 miles of our Woodland Hills Pulse ... locations. **Shift:** Monday to Friday from 8:00-5:00 pm PT The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- 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, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- Elevance Health (Rancho Cordova, CA)
- **Manager II Grievance/ Appeals - Claims Support** **Location: *CA Residential Requirement** This position will work a hybrid model (remote and office). Ideal ... within 50 miles of one of our PulsePoint locations. The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals … more
- Centene Corporation (Sacramento, CA)
- …California. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more