- Molina Healthcare (Tampa, FL)
- …appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed ... bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. * Meets claims production standards set by the… more
- CVS Health (Annapolis, MD)
- …with Provider Relations, Configuration, Compliance, Finance, Appeals and Grievance . and Medical Management. **Key Responsibilities** + Manage dailyMarylandMedicaid ... claims operations to ensuretimelyandaccurateclaimsadjudication and payment. + Direct and support claims supervisors, auditors, and analysts; provide coaching, workload direction, and performance management. + Oversee inventory levels, turnaround times (TAT),… more
- University of Colorado (Aurora, CO)
- …recruitment and retention. + Monitor student progress, retention activities, and grievance procedures for students; work with program's training committee(s), School ... of Medicine, Office of Research Education, and other graduate programs when necessary. + Utilize CUSIS (Milestones), Canvas, SOM (Oasis) and Graduate School (GAIA) databases; responsible for compilation and management of all student lifecycle data, including… more
- Fallon Health (Springfield, MA)
- …nursing "on-call" rotation as assigned. + Initiates and completes falls, infection, grievance and incident reports + Participates in CMS calls when deemed necessary. ... + Active participant in the site specific committees. + Participates in the post IDT huddle and any other additional meetings + Any additional tasks deemed necessary by the Clinical Nurse Manager and or Site Director. + Assumes the role of the home care nurse,… more
- Elevance Health (Mason, OH)
- …determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use ... of medical policies when making medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require + Medical Director review or policy interpretation. **Minimum Requirements:** + Requires MD or DO and Board… more
- US Marshals Service (Arlington, VA)
- …Personnel Management delegated examining unit, payroll, medical program, and grievance program. Formulate policies and prescribes rules, regulations, and procedures ... governing the execution of the Human Resources programs. Direct and evaluate special studies for the purpose of determining the effectiveness of the United States Marshals Service Human Resources programs. Project annual resource requirements and submits… more
- SUNY Suffolk County Community College (Selden, NY)
- …of the College community (including, but not limited to, vendors and visitors). Grievance procedures are available to interested persons by contacting either of the ... Civil Rights Compliance Officers/Coordinators listed below. Retaliation against a person who files a complaint, serves as a witness, or assists or participates in the investigation of a complaint in any manner is strictly prohibited. The following persons have… more
- SUNY Suffolk County Community College (Selden, NY)
- …of the College community (including, but not limited to, vendors and visitors). Grievance procedures are available to interested persons by contacting either of the ... Civil Rights Compliance Officers/Coordinators listed below. Retaliation against a person who files a complaint, serves as a witness, or assists or participates in the investigation of a complaint in any manner is strictly prohibited. The following persons have… more
- Win (Women In Need) (New York, NY)
- …investigations progress, including recommended solutions/outcomes. + Preparation of annual grievance reporting. Essential Functions: + Must be able to ascend/descend ... stairs in the shelter sites visited. + Must be able to sit for long periods of time at the computer. + Must be able to travel to Win sites within our footprint. + Must be able to attend Win sponsored events as necessary. Qualifications: + Commitment to Win's… more
- Chicago Transit Authority (Oak Park, IL)
- …investigation, employee interviews, and discussions with local Union representatives. + Prepares grievance responses at the first level of the process. + Responds to ... routine union questions and concerns directly and/or through interaction with other internal entities. + Observes and evaluates staff and supervisor performance for compliance with rules, regulations, and standard operating procedures (ie, employee contact,… more
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