- PDS Management Services, LLC (Suffern, NY)
- …Coordinates and maintains a system for receiving, processing, and resolving provider and member appeals and grievances following all applicable contract ... provisions, plan policies, procedures, rules, and regulations. Will be trained to manage the policy and procedures according to Federal and State regulations Analysis of trends for internal monitoring purposes and external reporting. Manages the communication… more
- Molina Healthcare (Yonkers, NY)
- …Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving member appeals and communicating resolution to members and provider (or ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers… more
