- Molina Healthcare (Yonkers, NY)
- …Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and resolving ... in line with state and federal regulations. Responsible for managing the Appeals and Grievance department inventories within the key performance requirements.… more
- Molina Healthcare (Rochester, NY)
- …Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, including 2 years in a manager ... and DRG/RCC pricing), and IPA. + 2 years supervisory/management experience with appeals / grievance and/or claims processing within a managed care setting.… more
- Humana (Albany, NY)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....member population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- Humana (Albany, NY)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors… more
- Humana (Albany, NY)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...member population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- Humana (Albany, NY)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director … more
- Molina Healthcare (Albany, NY)
- …procedures regarding compliance with local, state and federal guidelines. + Establishes member grievance appeals and policies and updates annually or as directed ... for Medicare and Medicaid Services. + Establishes non-contracted provider dispute and appeals policies and policies and updates annually or as directed by the… more
- MTA (Jamaica, NY)
- …other labor relations related tasks as deemed appropriate. Responsibilities: + Manage grievance and disciplinary cases appealed by the various unions to the Labor ... or modify decisions made by Department Heads/designees related to such appeals . Represent the LIRR at contract interpretation and disciplinary arbitrations. Prepare… more
- CUNY (New York, NY)
- …immigration. The Special Counsel serves as hearing officer of disciplinary and grievance proceedings and represents the College at higher levels of the disciplinary ... and grievance processes. The Special Counsel also serves as the...of College programs, units and College faculty, and the Director of Hunter College Campus Schools. Responsibilities include, but… more
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