- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances ... net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G)...appeals issues, preferably in a managed care or Medicaid Health Plan environment and/or public services or public… more
- Fallon Health (Worcester, MA)
- …other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH ... standards. The Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals &… more
- Elevance Health (Mason, OH)
- …providers, and regulatory entities, and serves as a subject matter expert for appeals , grievances , and quality of care issues. .Key responsibilities: serves as ... **Nurse Appeals -Licensed Nurse** **Location** : Ohio, candidates must...process is strongly preferred. .Basic knowledge of Medicare and Medicaid guidelines is preferred. .Proficiency in Microsoft Suite Products… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the...assigning all incoming appeals and grievances… more
- Sanford Health (Rapid City, SD)
- …and interaction with payers. Additional duties include management of medical denials, appeals , and grievances . Understand and provide insight into evaluating ... Details** Join our team as a Utilization Review and Case Management Manager and lead a high-impact, data-driven program that elevates patient outcomes while… more
- Molina Healthcare (Green Bay, WI)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
- J&J Family of Companies (Jackson, MS)
- …(ie, eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); REMs certification; Medicare and Medicaid ... + Interviews with the team: If you move forward, you'll meet with the hiring manager (and possibly others on the team) in one or two interview rounds, depending on… more
- J&J Family of Companies (Denver, CO)
- …(ie, eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); REMs certification; Medicare and Medicaid ... * Interviews with the team: If you move forward, you'll meet with the hiring manager (and possibly others on the team) in one or two interview rounds, depending on… more
- Healthfirst (NY)
- …but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions** + **Partner ... **Work experience and deep familiarity of health plans such as Medicare, Medicaid and//or Managed Long-Term Care Plan (MLTCP).** + **Demonstrated understanding of UM… more
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