• Director, Appeals & Grievances…

    Molina Healthcare (Cleveland, OH)
    …apply state level requirements to meet contract and regulatory expectations. * Establishes Appeals & Grievances department policies and procedures in line with ... and interprets trends and prepares reports that identify root causes for Appeals , Grievances , and Provider Disputes. Recommends and implements process… more
    Molina Healthcare (07/20/25)
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  • Director, Appeals & Grievances…

    Molina Healthcare (Akron, OH)
    …and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with the standards and requirements established by ... the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes that is responsible for reviewing and... and grievance processing/resolution, including 2 years in a manager role. * Experience reviewing all types of medical… more
    Molina Healthcare (07/18/25)
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  • IRE Grievance & Appeals Mgr II

    Elevance Health (Cincinnati, OH)
    …an accommodation is granted as required by law._ The ** Manager II Grievance/ Appeals ** responsible for management oversight of grievances and appeals ... ** Manager II Grievance/ Appeals ** **- Claims Support**...departmental units to investigate, resolve, and respond to grievances and appeals , manages inventory and production… more
    Elevance Health (07/15/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Cleveland, OH)
    …and Marketplace request authorization. Strongly prefer candidates with a background in appeals and grievances . Excellent computer multi-tasking skills and good ... office with internet connectivity of high speed required **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for … more
    Molina Healthcare (08/02/25)
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  • LTSS Service Coordinator (Case Manager )

    Elevance Health (Mason, OH)
    …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... **LTSS Service Coordinator (Case Manager )** **Hiring statewide across Ohio** **Location** : This...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
    Elevance Health (07/15/25)
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  • Pharmacy Technician II

    Elevance Health (Mason, OH)
    …relevant parties of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
    Elevance Health (08/01/25)
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  • Pharmacy Tech I

    Elevance Health (Mason, OH)
    …relevant parties of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
    Elevance Health (07/22/25)
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