- 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 ... degree and a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background. **Preferred Skills, Capabilities and Experiences:** + Strong preference for case… more
- Trinity Health (Gaithersburg, MD)
- …all activities pertaining to complaints, service delivery requests, and grievances / appeals , assures regulatory compliance and incident reporting including ... trend analysis for necessary action plans and quality improvement initiatives. + Plan, develop, organize, implement, evaluate, coordinate, and direct PACE program's infection control program in accordance with current rules, regulations, and guidelines that… more
- Elevance Health (Fresno, CA)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... degree and a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background. + Specific education, years, and type of experience may be required based upon state… more
- Molina Healthcare (Austin, TX)
- …remediate immediate and acute gaps in care and access. Assist members with filing grievances and appeals . * Connects members to CCEs, the OhioRISE Plan,or Molina ... Care Management if the members needs indicate a higher level of coordination. Provide information to members related to Molina requirements , services and benefits . * Knowledge of internal MCO processes and procedures related to Care Guide responsibilities… more
- Elevance Health (AZ)
- …relevant parties of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, ... sales team, and members related to formulary and prescription benefits. + Generates reports relating to rebates, physician utilization, Beers Criteria, Reliance members, and other ad hoc reports. + Maintains record keeping of prior authorizations, rebates, and… more
- Elevance Health (Atlanta, GA)
- …relevant parties of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, ... sales team, and members related to formulary and prescription benefits. + Generates reports relating to rebates, physician utilization, Beers Criteria, Reliance members, and other ad hoc reports. + Maintains record keeping of prior authorizations, rebates, and… more
- CVS Health (Carson City, NV)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... expectations are met or exceeded. + Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase… more
- State of Georgia (Colquitt, GA)
- …needs, and assists in student placement + Reports any faculty absences, student grievances and appeals , and other matters in accordance with college procedures; ... participates in the student academic appeal process; + Coordinates catalog reviews for programs under assigned supervision; + Facilitates procurement of program/course equipment and supplies; + Plans and implements a lab management and safety plan to ensure… more
- Henry Ford Health System (Detroit, MI)
- …Operations, Compliance, FDR oversight activities, Quality Management, Care Management, and/or Grievances and Appeals . + Demonstrated experience at a professional ... level, in an audit role, and in supporting compliance audit program initiatives. + Experience conducting compliance audits of a large multi-facility healthcare organization. + Demonstrates ability to think and work effectively under pressure and accurately… more
- Norfolk Southern (Atlanta, GA)
- …of railroad operations and long-term business goals. **Principal Duties** * Handles appeals of claims and grievances and disputes involving collective bargaining ... agreements for crafts under jurisdiction. * Prepares arbitration briefs and acts as oral advocate for managements position in front of arbitrators. * Prepares summary analysis and recommendations in discipline cases. * Conducts research on labor agreements and… more