- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: ... required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations...years of clinical acute care experience with at least 3 years of experience with health care grievance and/or… more
- Sanford Health (Sioux Falls, SD)
- … appeals and grievances , regulatory oversight, or health policy. At least 3 years in a leadership role managing appeals , grievances , or regulatory ... appeals and grievance resolution. Lead and manage the end-to-end appeals and grievances process for all product lines, ensuring compliance with federal and… more
- LA Care Health Plan (Los Angeles, CA)
- …Degree Experience Required: At least 3 years in a healthcare setting in Grievances and Appeals , Compliance, Claims or Call Center. At least 2 years of ... Supervisor, Customer Solution Center Appeals and Grievances (Temporary) Job Category: Management/Executive Department: CSC Appeals & Grievances Location:… more
- Molina Healthcare (MI)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... to work 1 Saturday a month M-F from 7am - 3 :30pm CST will require to work 1 Saturday a...internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to… more
- Dignity Health (Rancho Cordova, CA)
- …This position is hybrid in-office and work from home.** **Position Summary:** The Appeals and Grievances Coordinator is responsible for supporting the appeals ... regulatory requirements - facilitating timely and effective resolution of appeals and grievances . Acting a subject matter...similar administrative or coordination role. - Associates degree or 3 years of related job or industry experience in… more
- CareFirst (Baltimore, MD)
- …data and data related to the volume and complexity of the appeals and grievances submitted for resolution. **SUPERVISORY RESPONSIBILITY:** This position ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for members… more
- Elevance Health (Atlanta, GA)
- …and forwards to Medical Director for final review and decision. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + ... skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a...Experiences:** + AS or BS in Nursing preferred. + 3 years of clinical experience as a Registered Nurse… more
- Centene Corporation (New York, NY)
- …oversight and interpretation of state/federal regulations and NCQA standards impacting member appeals and grievances from a clinical perspective. Ensure that the ... clinical Appeals and Grievance department processes all cases in accordance...adherence **Education / Experience:** Bachelor's degree in Nursing preferred. 3 + years of combined nursing and appeal and grievance,… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances addressed to the Member Appeals & Grievances Department. This position will also provide administrative… more
- State of Colorado (Colorado Springs, CO)
- CDOC - Liaison III (Step 3 Grievance Responder) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123844) Apply CDOC - Liaison III (Step 3 ... (https://dhr.colorado.gov/state-employees/state-of-colorado-employee-benefits) for more information. Description of Job The Step 3 Grievance Responder examines complex issues affecting entire prison… more