• Principal Analytics Consultant - Medical…

    Health Care Service Corporation (Richardson, TX)
    …Job Qualifications:** + Experience with Utilization Management data (eg authorizations, appeals , grievances ) + Experience with DCMS healthcare data (eg ... claims. ICD10, DRG, APC, HCPCS, and/or CPT **This is a Flex (Hybrid) role: 3 days in office; 2 days work from home.** **Sponsorship is not available.** \#LI-PD1… more
    Health Care Service Corporation (10/16/25)
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  • Utilization Management Nurse

    Brighton Health Plan Solutions, LLC (NC)
    …review of services and care. * Provides referrals to Case management, Disease Management, Appeals & Grievances , and Quality Departments as needed. * Develop and ... * 2+ years' experience in a UM team within managed care setting. * 3 + years' experience in clinical nurse setting preferred. * TPA Experience preferred. Powered by… more
    Brighton Health Plan Solutions, LLC (10/11/25)
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  • CIC Registered Nurse - Hybrid

    Commonwealth Care Alliance (Boston, MA)
    …and supports, and community supports as approved + Supports escalation of member grievances and appeals + Supports the procurement of network providers and ... medical, behavioral health, and social needs **Desired Experience (nice to have):** + 3 + years of minimum experience working in outreach or in the community caring… more
    Commonwealth Care Alliance (10/02/25)
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  • Medicare/Medicaid Claims Reimbursement Specialist

    Commonwealth Care Alliance (Boston, MA)
    …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... AHIMA or Medicaid billing-related certifications **Required Experience (must have):** + 3 + years in healthcare claims processing, provider reimbursement, or payment… more
    Commonwealth Care Alliance (08/31/25)
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  • Standards Specialist

    City of New York (New York, NY)
    …of Correction ("DOC" or "the Department"); - Investigate serious incidents; - Review grievances from people in custody and staff; - Evaluate the performance of DOC; ... - Assisting in processing, evaluating and preparing responses to appeals from people in custody concerning the Minimum Standards...full-time paid experience as described in "1" above; or 3 . Education and/or experience equivalent to "1" or "2"… more
    City of New York (08/22/25)
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