- Elevance Health (Costa Mesa, CA)
- …for employment, unless an accommodation is granted as required by law._ The **Medicaid Grievance and Appeals Intake Analyst** is an entry level position in the ... Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from… more
- Sharp HealthCare (San Diego, CA)
- …and Grievance ProcessingUnder limited supervision, reviews and responds to appeals and grievances received from Commercial members and providers, in accordance ... documentation in department database to ensure accurate and thorough documentation of appeals / grievance process.Communicates both in written and oral form in a… more
- Sharp HealthCare (San Diego, CA)
- …and grievance processingUnder limited supervision, reviews and responds to appeals and grievances received from members and providers, in accordance with ... in IDX Customer Service Module to ensure accurate and thorough documentation of appeals / grievance process.Communicates both in written and oral form in a… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: At least 5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services ... Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC...Coordinates, tracks, and resolves internal and external appeal and grievance complaints for LA Care Plan Partners, including identifying… 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 ... and evaluation by the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB to identify areas of improvement to assist the… more
- CVS Health (Sacramento, CA)
- …carrying a modified case load including but not limited to:-Research incoming electronic appeals , complaints and grievance to identify if appropriate for unit ... resource and reroute inappropriate work items that do not meet appeals , complaints and grievance criteria. + Research Standard Plan Design or Certification of… 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 ... inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance /appeal requests, and prepares UM Activity and Weekly Compliance… more
- Humana (Sacramento, CA)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.… more
- Elevance Health (Costa Mesa, CA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... consistent use of medical policies when making medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require + Medical Director review or policy interpretation. **Minimum Requirements:** + Requires MD or DO and… more
- Humana (Sacramento, CA)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of… more