- SYSCO (Union City, CA)
- …laws Investigate problems, such as working conditions, disciplinary actions, and associate and applicant appeals Provide guidance and recommendations for ... Oversee the performance management process, working with OpCo leaders on their associate reviews and coaching, providing training and consultation as necessary Work… more
- CHRISTUS Health (Alamogordo, NM)
- …Medicare Conditions of Participation, DNV standards, HIPAA, and reporting requirements. Submits appeals in a timely manner, upon request by the Director. Initiates ... Complies with the Utilization Management Plan. Requirements Education Required: Associate of Science Licenses & Certifications Required: L-RN Singlestate Preferred:… more
- CVS Health (Hartford, CT)
- …1+ years of Coding experience + Utilization Review experience + Medicare experience + Appeals experience Education + Associate RN Degree or RN Diploma required ... 8a-5p in time zone of residence. Position Summary The Appeals Nurse Consultant position is responsible for processing the...for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is… more
- CVS Health (Harrisburg, PA)
- …to make health care more personal, convenient and affordable. Position Summary The Associate Manager will assist in the hiring and managing of the Medicare ... Complaints Team staff. The Associate Manager must possess outstanding people skills, exercise good judgement, and contribute to a team environment. Ability to build… more
- Universal Health Services (Richmond, VA)
- …or equivalent, Associate 's degree or higher preferred + 3-5 years appeals experience preferred + Strong Microsoft Office skills (Excel, Word, Outlook) + Ability ... Atlantic Region CBO is seeking a dynamic and talented Senior Appeals Specialist. The Senior Appeals Specialist is responsible for the resolution of all … more
- Magellan Health Services (San Diego, CA)
- Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests. In some cases may be ... medical necessity reviews. + Enters all data related to appeals and case reviews into a database. + Prepares...Education - Required GED, High School Education - Preferred Associate License and Certifications - Required License and Certifications… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- Centene Corporation (Salem, OR)
- …and scanning incoming mail **Education/Experience:** High school diploma or equivalent. Associate 's degree preferred. 2+ years grievance or appeals , claims ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Grievance and Appeals Coordinator 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #660 Wednesday, June 5, 2024 Centers Plan for Healthy Living's goal is to ... healthy living. JOB SUMMARY: As an integral part of the Grievance and Appeals (G&A) Department, the G&A Coordinator lends their support in processing member-related… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting… more
