- Elevance Health (Tampa, FL)
- **Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... unless an accommodation is granted as required by law._ The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- TEKsystems (Portland, OR)
- Professional Summary: The Appeals Specialist I is responsible for managing provider billing disputes and appeals with precision and professionalism. This role ... internal policies. While not responsible for making final clinical decisions, the Appeals Specialist I works closely with licensed health professionals to support… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is...will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to… more
- Elevance Health (Costa Mesa, CA)
- …an accommodation is granted as required by law._ The **Medicaid Grievance and Appeals Intake Analyst** is an entry level position in the Enterprise Grievance & ... Appeals Department that reviews, analyzes and processes non-complex pre...processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, regulatory… more
- Centene Corporation (Phoenix, AZ)
- …**Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. ... verbal and written member and provider complaints, grievances and appeals + Prepare response letters for member and provider...response letters for member and provider complaints, grievances and appeals + Maintain files on individual appeals … more
- Molina Healthcare (Atlanta, GA)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving member and provider ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related… more
- City of New York (New York, NY)
- …Department is seeking applicants for an Assistant Corporation Counsel position in its Appeals Division. The Appeals Division handles appeals originating from ... before federal and state appellate courts and are responsible for briefing and arguing appeals in an array of cases, from routine litigation arising out of the… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals according ... and/or escalates denial when appropriate. Submits all (initial and/or appeals ) reviews and/or letters within contractual or regulatory timeframes. Collaborates… more
- Centene Corporation (Frankfort, KY)
- …preferred. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- New York State Civil Service (Albany, NY)
- …Agency Court Administration, Office of Title Court Attorney Clerkship (Court of Appeals ) Occupational Category Legal Salary Grade 26 Bargaining Unit None listed ... 12207 Duties Description The New York State Court of Appeals , is seeking applications for TWO-YEAR CLERKSHIPS in the...and issues presented in motions to the Court of Appeals ; review and analyze appellate records and briefs; and… more
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