• IRE Grievance & Appeals Mgr II

    Elevance Health (Durham, NC)
    …unless an accommodation is granted as required by law._ The **Manager II Grievance/ Appeals ** responsible for management oversight of grievances and appeals ... departmental units to investigate, resolve, and respond to grievances and appeals , manages inventory and production levels, and operational and plan risk,… more
    Elevance Health (07/15/25)
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  • Appeals Specialist I (remote)

    CareFirst (Baltimore, MD)
    …for collecting, organizing and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources. We are ... **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial...Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps… more
    CareFirst (07/30/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (GA)
    …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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  • Medicare Grievances and Appeals…

    Humana (Little Rock, AR)
    …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and… more
    Humana (06/18/25)
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  • Grievance & Appeals Specialist

    Robert Half Accountemps (Los Angeles, CA)
    …Strong knowledge of Basic Medical Terminology * Proven track record in handling Appeals and Medical Grievances * Excellent coordination and organization skills * ... is in the immediate need of a Grievance & Appeals Specialist. The Grievance & Appeals Specialist, will be in responsible for investigating, documenting, and… more
    Robert Half Accountemps (07/20/25)
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  • Medical Director, Grievances

    UPMC (Pittsburgh, PA)
    …improvement review processes, including concurrent, prospective and retrospective reviews, member grievances , provider appeals , and potential quality of care ... a board-certified physician with a Pennsylvania Medical License for a Medical Director, Grievances role with UPMC Community Health Choices. This role is fully remote… more
    UPMC (06/29/25)
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  • Grievance & Appeals Coordinator II

    Centene Corporation (Phoenix, AZ)
    …appeals from providers and members. Resolve all State inquires related to complaints, grievances and appeals . + Review and process member and provider ... grievances and appeals within federal, state and organizational regulations and policies...appeal decisions. + Act as subject matter expert regarding grievances and appeals . + Lead Appeals… more
    Centene Corporation (07/29/25)
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  • Spec, Quality Assurance I

    TEKsystems (Reston, VA)
    …claims to assist medical professional staff in performing the review of appeals grievances and reconsiderations. Prioritize research analyze and perform accurate ... Specialist II will be responsible for the initial intake analysis of appeals / grievances correspondence and determination of next steps with minimal supervision… more
    TEKsystems (07/25/25)
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  • Director, Operational Oversight (Medicare/Duals)…

    Molina Healthcare (Albany, NY)
    …and delegated vendors must follow, and you keep complaint data synchronized across appeals & grievances , enrollment, claims, pharmacy, and quality functions. You ... 2. Workflow Integration - Embed CTM insights into downstream operations-Stars, appeals & grievances , enrollment, claims-so each team addresses systemic… more
    Molina Healthcare (07/29/25)
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  • Customer Solution Center Audit Readiness…

    LA Care Health Plan (Los Angeles, CA)
    …Solution Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This position is responsible… more
    LA Care Health Plan (07/17/25)
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