- Elevance Health (Mason, OH)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, ... an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Mason, OH)
- …providers, and regulatory entities, and serves as a subject matter expert for appeals , grievances , and quality of care issues. .Key responsibilities: serves as ... **Nurse Appeals -Licensed Nurse** **Location** : Ohio, candidates must...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (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 )** **Candidates should live in one of the...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Guardian Life (Columbus, OH)
- …contact for all assigned DSOs. Respond to provider inquiries, concerns, complaints, appeals and grievances within assigned timeframes. Collaborate across teams ... to Dental Support Organization (DSO) partners. As a **Key DSO Dental Account Manager , Dental Support Organizations** , you will be responsible for growing the… more
- Molina Healthcare (OH)
- …to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with ... The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… more
- Sharecare (Columbus, OH)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances / appeals , utilization management (UM) status, including but not limited to ... payers or 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management...Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide +… more
- Elevance Health (Mason, OH)
- **Grievance and Appeals Analyst II (Executive Concierge Analyst)** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering ... unless an accommodation is granted as required by law. The **Grievance and Appeals Analyst II** is responsible for providing support services for multiple states,… more
- Molina Healthcare (Akron, OH)
- …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
- 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
- Centene Corporation (Columbus, OH)
- …division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point ... groups, and/or ancillary providers within assigned area. + Act as account manager for assigned groups acting as gatekeeper for interactions with other internal… more