- Elevance Health (Woodbridge, NJ)
- ** Manager II Grievance / Appeals ** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... employment, unless an accommodation is granted as required by law._ The ** Manager II Grievance & Appeals ** responsible for management oversight of grievances… 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 ... Grievance Responder) Salary $4,906.00 - $7,849.00 Monthly Location Colorado...establish an eligible list for referral to the hiring manager for final consideration. Use of artificial intelligence (AI)… more
- 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: Los ... net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General...and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …guidelines including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals , Utilization Review, and Grievance processes including benefit interpretation, ... clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal and Grievance Nurse is responsible for conducting daily clinical and benefit… more
- Elevance Health (Charlotte, NC)
- …by medical directors and consultants; preparing recommendations to uphold or deny appeals ; and ensuring all grievance processes are completed within regulatory ... paralegal experience is strongly desired. + Understanding of the grievance and appeals process is strongly preferred....Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (South Charleston, OH)
- …**Job Summary** Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and ... Manages staff responsible for the submission/resolution of member and provider inquiries, appeals and grievances for the Plan. Ensures resolutions are compliant. +… more
- Elevance Health (Atlanta, GA)
- **Nurse Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... between those hours, including holidays on a rotational basis. The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- Elevance Health (Costa Mesa, CA)
- **Nurse Appeals RN-Quality of Care** **Location: California-Costa Mesa, Walnut Creek, or Woodland Hills** **Hybrid 1:** This role requires associates to be in-office ... Work Hours:** Monday-Friday, 8:00AM -5:00 PM Pacific Standard Time The **Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Elevance Health (Metairie, LA)
- **Nurse Appeals RN-Quality of Care** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while ... Work Hours:** Monday-Friday, 8:00AM -5:00 PM Eastern Standard Time The **Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH… more
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