- Commonwealth Care Alliance (Boston, MA)
- …including provider listings in their areas. - Complete comprehensive appeal and grievance intakes. - Collaborate with the member to accurately document their appeal ... or grievance concern by ensuring all necessary information to start...preferred - Prior experience with service authorizations, grievances and appeals , scheduling medical appointments preferred - Ability to work… more
- Elevance Health (Woodbridge, NJ)
- **Manager II Grievance / Appeals ** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... an accommodation is granted as required by law._ The **Manager II Grievance & Appeals ** responsible for management oversight of grievances and appeals … more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and ... of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.… more
- Motion Recruitment Partners (Birmingham, AL)
- Claims Appeals and Grievance Coordinator Birmingham, Alabama **Onsite** Contract $18/hr - $28/hr Are you detail-oriented, highly organized, and passionate about ... making a difference in healthcare? We are seeking several Appeals and Grievances Coordinators for an onsite contract opportunity in Birmingham, AL. In this role,… more
- AmeriHealth Caritas (Philadelphia, PA)
- …of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial ... in a Managed Care environment + 1 to 3 years' experience in grievance / appeals environment required **The Ideal Person will have:** + Proven experience as a… more
- CVS Health (Hartford, CT)
- …AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly ... of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C ...Appeals :** * Direct daily work on part C appeals (both provider and member/nonparticipating providers). * Provide direct… more
- LA Care Health Plan (Los Angeles, CA)
- …the Clinical Programs. + Develop and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best in clinical appeals ... experience with at least 3 years of experience with health care grievance and/or appeals issues, preferably in a managed care or Medicaid Health Plan environment… 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 ... and/or paralegal experience is strongly desired. + Understanding of the grievance and appeals process is strongly preferred. + Basic knowledge of Medicare and… 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
- Molina Healthcare (Columbus, OH)
- …**Job Summary** Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and ... tracking system and database of correspondence and outcomes for provider and member appeals ; monitors each appeal to ensure all internal and regulatory timelines are… more
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