- Sanford Health (Sioux Falls, SD)
- …governing appeals and grievance resolution. Lead and manage the end-to-end appeals and grievances process for all product lines, ensuring compliance with ... Oversee the intake, review, resolution, and documentation of all appeals , complaints, and grievances to meet regulatory...and documentation of all appeals , complaints, and grievances to meet regulatory and operational standards. Ensure all… more
- Elevance Health (Tampa, FL)
- …appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + Documents ... entities. + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non… more
- Dignity Health (Rancho Cordova, CA)
- **Job Summary and Responsibilities** The Appeals and Grievances LVN is a critical role responsible for managing and resolving all medical necessity appeal ... and maintaining patient confidentiality (HIPAA) are also essential. Ultimately, the Appeals and Grievances Nurse monitors denial trends, recommends corrective… more
- Volunteers of America Upstate New York (Rochester, NY)
- …standards. Resident Services & Accountability - Assist with escalated discipline, grievances , appeals , and behavioral interventions. - Support intake/orientation ... Travel Percentage Up to 25% Description Position Title: Assistant Director - RRC Grade: Category : Exempt Reports to:... - RRC Grade: Category : Exempt Reports to: Director Salary : $65,000 Our Mission: To enable people… more
- CVS Health (Tallahassee, FL)
- …needed and state calls. Understand UM and participate in UM front line work and appeals in markets as needed. * Confer directly with providers regarding the care of ... through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical coverage review, member… more
- AmeriHealth Caritas (Washington, DC)
- …Management, Program Integrity, Risk Adjustment, Provider Resolution Team, Provider Appeal and Grievances , Member Appeals and Grievances , Network adequacy and ... **Job Responsibilities** The Director Operations (Healthy DC Plan) reports to the...all relevant federal, state, and local regulatory requirements. The Director Operations Healthy DC Plan is accountable for ensuring… more
- City of New York (New York, NY)
- …and administer the contractual grievance process. Serve as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before ... planning, payroll management, compliance, labor relations, and policy implementation. The Director of Labor and Employee Relations will report to the Deputy… more
- Herkimer County Community College (Herkimer, NY)
- …and serve as the lead administrator for negotiations with bargaining units. Facilitate grievances and employee appeals related to working conditions and contract ... Job Description: Herkimer College is seeking qualified applicants for a full-time Director of Human Resources. This position provides overall coordination of human… more
- Sioux City Community School District (Sioux City, IA)
- Job Details Job ID: 5460842 Job Description EXECUTIVE SUMMARY The Executive Director supports the mission of the Sioux City Community School District by fostering ... and develop communication for donor stewardship including thank you letters, appeals , newsletters, social media, impact reports, and other communications. + Plan… more
- Dignity Health (Bakersfield, CA)
- … of Utilization Management in medical review activities, peer-to-peer consultations, appeals and grievances and other related duties. **Job Requirements** ... primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing and driving… more
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