- 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, ... that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage process for… 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 & ... Grievances Location: Los Angeles, CA, US, 90017 Position Type:...purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for… 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 ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider… more
- Humana (Sacramento, CA)
- …+ MD or DO degree + A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of ... assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be… more
- Humana (Sacramento, CA)
- …+ MD or DO degree + A current and unrestricted license in at least one state and willing to obtain license, as required, for various states in region of assignment + ... Board Certified in an approved ABMS Medical Specialty + **Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, Physical Medicine and Rehab, Anesthesiology or General Surgery trained** + Excellent written and communication skills + 5… more
- Sharp HealthCare (San Diego, CA)
- …for the investigation, documentation and resolution of Commercial member appeals and grievances in compliance with State law, rules, and guidelines; provider and ... (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible for non-clinical… more
- Sharp HealthCare (San Diego, CA)
- …Responsible for the investigation, documentation and resolution of member appeals and grievances in compliance with State law, rules, and guidelines; provider and ... (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible for non-clinical… more
- Elevance Health (Costa Mesa, CA)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, regulatory ... of service, and quality of care issues to include executive and regulatory grievances . **How you will make an impact:** + Reviews, analyzes and processes non-complex… more
- Ventura County (Ventura, CA)
- …provisions, with your recommendations playing a key role in effectively resolving grievances . Additionally, you will play a crucial role in arbitration preparation, ... they are instrumental in the resolution of formal and informal grievances , arbitration requests, and guiding the organization through any necessary reductions… more
- The Walt Disney Company (Anaheim, CA)
- …and interpretation of site-specific collective bargaining agreements through consultations, grievances and resolution of labor-management issues. This position also ... day-to-day Labor Relations services and provide counsel on consultations, grievances , negotiations, arbitrations and effects bargaining. + Facilitate ongoing… more