- State of Colorado (Limon, CO)
- …plans, and conducts performance evaluations; resolves informal staff and/or inmate grievances . Assigns tasks, monitors and inspects work progress and ensures ... inmate hours and pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and creates real life… more
- CHS (Clearwater, FL)
- …client trust. * Investigates and participates in formal responses relating to complaints, grievances and appeals received by or applicable to PAS. Participates ... **Overview** **Claims Manager ** **Servicing** **Health Insurance Policies or Benefits** **Summary:** Premier Administrative Solutions (PAS) is a Third-Party… more
- Elevance Health (IN)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + BA/BS degree ... **LTSS Service Coordinator (Case Manager )** **Location:** Seeking candidates to work in Greene,...clinical healthcare management and interdisciplinary team in order to provide care coordination support. + Manages non-clinical needs of… more
- Elevance Health (Norfolk, VA)
- …unless an accommodation is granted as required by law. The **Vendor Implementation Manager ** is responsible for Provider Network 3rd party delegated dental, ... **Vendor Implementation Manager ** **Hybrid 1:** This role requires associates to...Transportation) strongly preferred + Experience with Medicaid and Medicare grievances and appeals processes + Experience with… more
- AmeriHealth Caritas (Washington, DC)
- …internal metrics and regulatory requirements, including call center SLAs, member and provider grievance & appeals , claims timeliness, provider credentialing, ... **Job Responsibilities** The Performance Sustainability Manager (Healthy DC Plan) will report directly to...Coordinates problem resolution efforts with the Medical Affairs and Provider Services departments regarding complaints and grievances … more
- Elevance Health (Chillicothe, OH)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... **LTSS Service Coordinator (Case Manager )** **Hiring near Cambridge, Colerain, Chillicothe, Coschocton, Hillsboro, Ironton, Mansfield, Marion, Mount Orab, Mount… more
- LA Care Health Plan (Los Angeles, CA)
- …technical aspects of the retrospective review process for authorizations and Member or Provider Appeals , including, but not limited to computer data entry, ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and … more
- Sharecare (Albany, NY)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances / appeals , utilization management (UM) status, including but not limited to ... an exciting and innovative remote role newly created to provide meaningful support to members and their families through...payers or 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …must maintain licensure throughout employment + Minimum of 5 years' experience in Clinical Appeals and Grievances within a managed care or payor setting + ... quality-focused, production-driven environment. The position reports directly to the Clinical Appeal Manager . Note: This job description is not intended to be an… more
- Sharp HealthCare (San Diego, CA)
- …+ Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify trends in ... care needs of the membership. Serves as a medical manager and policy advisor to SHP and its Chief...plan functions that interface with medical management such as provider relations, member services, benefits and claims management, etc.… more