- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... No **Essential Duties & Responsibilities** Processing of Grievances & Appeals : + Responsible for the progress of grievance... Appeals : + Responsible for the progress of grievance and appeal intervention and resolution. + Assure verbal… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...This position will focus on quality review of non-clinical grievance and appeals cases for all line… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Molina Healthcare (Atlanta, GA)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving member and provider ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related… more
- Commonwealth Care Alliance (Boston, MA)
- …& Responsibilities:** + Conduct monthly case review of a random sample of appeals and grievance cases against previously developed scorecard and Federal and ... 011540 CCA- Appeals & Grievances **Position Summary:** Appeals ...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- LA Care Health Plan (Los Angeles, CA)
- …track all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals ... Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the… more
- Molina Healthcare (Vancouver, WA)
- …Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the ... subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of access and care… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …referrals generated to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department ... Depending on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of the programs of Utilization… more
- Johns Hopkins University (Baltimore, MD)
- …actions and make sound recommendations to management. + Manage the grievance process, including fact finding, reviewing evidence, serving as hearing officer, ... as an advisor to employees and management on employee appeal and grievance issues. + Work in partnership with department management regarding appropriate… more
- New York State Civil Service (Albany, NY)
- …Section 75 of the Civil Service Law.*Oversee the agency's employee grievance program, ensuring proper processing consistent with bargaining unit agreements. Assist ... to the HR Director,Agency Executives, on investigations, disciplinary and grievance matters, and assist with special projects as needed.*Develop, draft,… more