- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... **Supervision Exercised:** No **Essential Duties & Responsibilities** Processing of Grievances & Appeals : + Responsible for the progress of grievance and appeal… more
- Robert Half Accountemps (Los Angeles, CA)
- Description A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist . The Grievance & Appeals Specialist , ... and resolving denied claims, complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform… more
- LA Care Health Plan (Los Angeles, CA)
- …providers. Duties Provide non- clinical support to the Customer Solution Center Appeals and Grievance Specialists for L. A. Care's Medicare Advantage program. ... responses. (25%) Under the supervision of the Appeals and Grievance Manager, assist with soliciting non- clinical information from Participating Physical… more
- Tufts Medicine (Boston, MA)
- …involving a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee ... union contract administration including the investigation of grievances, drafting grievance responses, MOA preparation. 6. Coordinates and prepares information for… more
- State of Colorado (CO)
- …Job Number CAA Physician 06/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 06/05/2025 Closing Date 10/31/2025 ... on-call assessment, diagnosis, and treatment of inmates in one or more prison clinical settings. Physicians are responsible for, but not limited to, the following: +… more
- Elevance Health (Los Angeles, CA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... ** Clinical Operations Associate Medical Director** **Carelon MBM -...health profession. **Preferred skills, capabilities, and experiences:** + Oncology specialist preferred + Internal medicine specialist preferred… more
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