- 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
- Centene Corporation (Pittsburgh, PA)
- …annual, and ad-hoc audits. + Manage daily entries into the DBHS Office of Grievance and Appeals database. + Coordinate with all relevant departments, as ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- LA Care Health Plan (Los Angeles, CA)
- …in a consistent and accurate manner. This position will focus on quality review of non- clinical grievance and appeals cases for all line of business (LOB) ... Customer Solution Center Appeals and Grievances Quality Auditing Specialist ...executing, tracking, and assessing targeted and random audits for non- clinical grievance and appeal case documentation. Ensure… 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …referrals generated to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department ... on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of the programs...Plan Essential Accountabilities: Level I + Review / prep clinical case for clinical staff. + Navigates… more
- LA Care Health Plan (Los Angeles, CA)
- …track all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals ... Authorization Technician II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID:… more
- State of Colorado (Pueblo, CO)
- …CAA P/T 3557 Physician 5/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 05/12/2025 Closing Date 9/18/2025 4:00 ... 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
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