- Elevance Health (Atlanta, GA)
- …and forwards to Medical Director for final review and decision. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + ... skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a...Experiences:** + AS or BS in Nursing preferred. + 3 years of clinical experience as a Registered Nurse… more
- Molina Healthcare (Macon, GA)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
- Molina Healthcare (Augusta, GA)
- …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the...**I** **E** **N** **C** **E/KNOWLEDGE, SKILLS & ABILITIES:** + 3 + years relevant experience, including: + 2 years previous… more
- Molina Healthcare (Atlanta, GA)
- …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- Elevance Health (Atlanta, GA)
- …Dental, Transportation) strongly preferred + Experience with Medicaid and Medicare grievances and appeals processes + Experience with network development ... **Required Qualifications:** + Requires a BA/BA degree and a minimum of 3 years of business analysis, process improvement, project management, network management or… more