- LA Care Health Plan (Los Angeles, CA)
- …required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory ... clarification on initial responses. (25%) Under the supervision of the Appeals and Grievance Manager , assist with soliciting non-clinical information from… 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...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)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances...5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health… more
- LA Care Health Plan (Los Angeles, CA)
- …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and cohesive unit with...the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB… more
- Sacramento Municipal Utility District (Sacramento, CA)
- …with one or more collective bargaining units, including day-to-day contract management, grievance response and resolution, and labor negotiations. The intent of this ... minimum qualifications listed in this posting. **Purpose** Assists the Manager , Labor Relations in the development, coordination, implementation, and administration… more
- LA Care Health Plan (Los Angeles, CA)
- …all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters ... collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory… more
- Sharp HealthCare (San Diego, CA)
- …Chief Medical Officer and reports findings in conjunction with the Quality Improvement Manager . + Participates in the grievance process with the Chief Medical ... policy as needed. + Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager to identify trends… more
- Sharp HealthCare (San Diego, CA)
- …to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager to identify ... needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its'...data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources. + Achieves and maintains… more