- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other related quality program activities including: monthly case quality monitoring, coordination of… more
- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This position is responsible… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty level … 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, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
- Molina Healthcare (New Haven, CT)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
- Healthfirst (PA)
- …+ Bachelors degree + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization ... management/case management. + Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently on several computer applications such as Microsoft Word… more
- Healthfirst (NY)
- **Duties and Responsibilities:** + Conduct quality audits of A&G items cases grievances , pre-service appeals , and post service appeals utilizing appropriate ... information required to complete the audit. + Review and investigate appeals and grievances requests to ensure all requests are identified, classified, and fully… more
- Healthfirst (NY)
- + Conduct quality audits of A&G items including grievances , pre-service appeals , and post service appeals utilizing appropriate sources of information; ... processes and performance to ensure quality. + Review and investigate appeals and grievances requests to ensure all requests are identified, classified, and… more
- VNS Health (Manhattan, NY)
- …opportunity to: * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare ... our high standards for operational and regulatory compliance in managing grievances and appeals on our behalf. * Data-Driven Decisions: Maintain the integrity of… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances addressed to the Member Appeals & Grievances Department. This position will also provide administrative… more
Related Job Searches:
Appeals,
Appeals Grievances Coordinator,
Appeals Grievances Medical Director,
Grievances,
Grievances Appeals Representative,
Manager Appeals Grievances,
Manager II Grievances Appeals,
Medicare Grievances Appeals Corporate,
Specialist Appeals Grievances,
Supervisor Appeals Grievances