- 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 Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... 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 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
- 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
- University of Southern California (Los Angeles, CA)
- …support the unit in designing labor strategies, contract negotiations, grievances , discipline hearings, arbitrations, and other matters regarding labor relations, ... + Knowledge of leading practice procedures used to investigate and resolve grievances including approaches to reducing bias during the investigation process. +… 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
- UCLA Health (Los Angeles, CA)
- …ensuring adherence to contract provisions, participating in negotiating sessions, and addressing grievances and questions of a specific group of union employees. In ... with the ER/LR manager, you will evaluate merits of grievances and complaints and draft response letters accordingly. Under...Relations Managers as well as track the status of grievances . In this role, you will also support Labor… more
- LA Care Health Plan (Los Angeles, CA)
- …Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ... and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This position is responsible for… more
- City and County of San Francisco (San Francisco, CA)
- …will perform the following essential duties: + Negotiate resolutions to grievances , investigating complaints of serious employee misconduct, and confer with ... prompt investigations regarding misconduct and whistleblower complaints. + Respond to grievances and represents department during expedited arbitrations; serves as a… more
- LA Care Health Plan (Los Angeles, CA)
- …nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters to Grievances Specialist on daily basis. ... (20%) Support UM Committee and Audit activity via Department performance reporting. Assure the accuracy of reports concerning inventory and department proficiency in maintaining regulatory standards and time frames. (5%) Perform other duties as assigned. (10%)… more