- Harbor Health Services, Inc. (Mattapan, MA)
- …process improvement, communication to employees about QI efforts. Working with the Appeals and Grievances Specialist, maintains oversight of the Grievances ... consistency of decisions. Supervisory responsibilities for UM RN, Quality Analyst, Appeals and Grievances Specialist. Requirements: Bachelor's Degree required,… more
- San Francisco Health Plan (San Francisco, CA)
- …quality review functions, ensuring timely and compliant resolution of clinical grievances , appeals , potential quality issues (PQIs), provider dispute ... WILL DO: Provide subject matter expertise and high-level oversight of clinical grievances and appeals , PQIs, provider dispute resolutions, corrective action… more
- San Francisco Health Plan (San Francisco, CA)
- …develop and implement an operational strategy for D-SNP Customer Services and Grievances and Appeals functions. Develop internal communication documents and ... product development, process improvement or product management, within a Medicare environment. 3 or more years of leadership/people management experience. 2 or more… more
- SKYGEN (Menomonee Falls, WI)
- …client's Member Services staff to resolve issues such as eligibility and filing appeals and grievances . Provide updates to providers with questions regarding the ... - Friday CST Work schedule (after training): 9:00am - 3 :00pm CST Monday - Friday CST Hours of operation:...holidays possible during Annual Medicare Open Enrollment: 10/1 - 3 /31 Exceptional professional growth in a fun rewarding environment… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: ... required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations...years of clinical acute care experience with at least 3 years of experience with health care grievance and/or… more
- Sanford Health (Sioux Falls, SD)
- … appeals and grievances , regulatory oversight, or health policy. At least 3 years in a leadership role managing appeals , grievances , or regulatory ... appeals and grievance resolution. Lead and manage the end-to-end appeals and grievances process for all product lines, ensuring compliance with federal and… more
- Dignity Health (Rancho Cordova, CA)
- …This position is hybrid in-office and work from home.** **Position Summary:** The Appeals and Grievances Coordinator is responsible for supporting the appeals ... regulatory requirements - facilitating timely and effective resolution of appeals and grievances . Acting a subject matter...similar administrative or coordination role. - Associates degree or 3 years of related job or industry experience in… 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
- Elevance Health (Cerritos, CA)
- …+ HS diploma or GED. + Minimum of 3 years experience working in grievances and appeals , claims, or customer service; or any combination of education and ... reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, regulatory and… more
- CareFirst (Baltimore, MD)
- …for collecting, organizing and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources. We are ... **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial...**QUALIFICATIONS:** **Education Level:** High School Diploma or GED. **Experience:** 3 years experience in settings such as managed care,… more
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