- Covenant Health Inc. (Knoxville, TN)
- Overview Insurance Appeals Senior , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is ... integrity auditor to take appropriate action. Prepares necessary documentation for insurance appeals process, ensuring timely follow through. Processes claim… 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: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- Sanford Health (Sioux Falls, SD)
- … and grievances resolution. Oversee training and professional development programs for appeals and grievances staff to maintain expertise and regulatory ... oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, including ACA,… more
- Banner Health (AZ)
- …and in support of related regulations and policies and procedures to member, staff and physician grievances, appeals and claim disputes with minimal supervision. ... **Department Name:** Grievances & Appeals **Work Shift:** Day **Job Category:** General Operations...as an innovative leader in new health care models, insurance plans and physicians are coming together to work… more
- Centene Corporation (Sacramento, CA)
- …Hills or Natomas offices **Position Purpose:** Ensure appropriate processing of member grievance appeals , provider appeals , or request for a State Fair Hearing. ... the day to day responsibilities of the Grievance & Appeals Coordinators. + Ensure that the Grievance and ...+ Recommend solutions and works with department and company staff to ensure problems are corrected and departments are… more
- Martin's Point Health Care (Portland, ME)
- …with appeals leadership and Compliance. + Identify, develops, and provides staff education/training related to appeals . + Maintains education, awareness, and ... + Independently partners with Medical Directors and other clinical support staff on appeals requiring clinical decision-making determinations. + Conducts… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to clinical denial management. ... conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based on clinical documentation… more
- Catholic Health Services (Melville, NY)
- …advisors and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager. + Assist with all insurance and regulatory audits ... Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and… more
- Evolent (Montpelier, VT)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of...policies and procedures. + Documents communications with medical office staff and/or MD provider as required. + Interfaces with… more
- MTA (Brooklyn, NY)
- Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... Posted: Jul 10, 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date of Filing: Until Filled… more