• Specialist, Appeals & Grievances…

    Molina Healthcare (Rochester, NY)
    …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... to work 1 Saturday a month M-F from 7am - 3 :30pm CST will require to work 1 Saturday a...internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to… more
    Molina Healthcare (10/26/25)
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  • Supervisor, Clinical Grievance and Appeals

    Centene Corporation (New York, NY)
    …oversight and interpretation of state/federal regulations and NCQA standards impacting member appeals and grievances from a clinical perspective. Ensure that the ... clinical Appeals and Grievance department processes all cases in accordance...adherence **Education / Experience:** Bachelor's degree in Nursing preferred. 3 + years of combined nursing and appeal and grievance,… more
    Centene Corporation (10/31/25)
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  • Hearing Officer

    City of New York (New York, NY)
    …subpoenas on the following: Termination - Tenancy - Leased Housing/Section 8 Subsidy Grievances - Remaining Family Member - Tenant Initiated, such as Rent ... Grievances and Reasonable Accommodation Requests - Leased Housing/Section 8...Calculation and Section 8 Reasonable Accommodation Requests - Over-Income Appeals - Applicant or Trespass - Tenant Reasonable Accommodation… more
    City of New York (10/19/25)
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  • Clinical Registered Nurse - Utilization Management…

    Cognizant (Albany, NY)
    …or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews . ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
    Cognizant (10/07/25)
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  • Agency Attorney Intern

    City of New York (New York, NY)
    …United States law school as defined in the Rules of the New York Court of Appeals (Sections 520. 3 or 520.5) or admission to the New York State Bar. Additional ... related to labor law and employee discipline. The unit handles employee grievances , prosecutes disciplinary cases, and works with attorneys at the Mayor's Office… more
    City of New York (09/16/25)
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  • Assistant General Counsel

    City of New York (New York, NY)
    …issues including license and access issues, leasing, and eminent domain 3 ) procurement related issues including responsive and responsibility issues, bid protests, ... the Uniform Commercial Code ("UCC"); 10) assist division staff with procurement appeals and decision process, including draft opinions and presenting facts and… more
    City of New York (08/13/25)
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  • Senior Labor Relations Representative

    MTA (New York, NY)
    …and participate in monthly conferences with union representatives to discuss contract grievances and employee discipline appeals ; perform analytical review of ... Authority is North America's largest transportation network, serving a population of 15. 3 million people across a 5,000-square-mile travel area surrounding New York… more
    MTA (08/16/25)
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  • Medical Director (NV)

    Molina Healthcare (Buffalo, NY)
    …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 (10/31/25)
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  • Medical Director

    Molina Healthcare (Rochester, NY)
    …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 (10/22/25)
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  • Medical Director (AZ)

    Molina Healthcare (NY)
    …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
    Molina Healthcare (10/17/25)
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