- 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)...cross-functional departments to appropriately address and resolve member and provider grievances . + Responsible for timely daily… more
- Molina Healthcare (South Charleston, OH)
- …**KNOWLEDGE/SKILLS/ABILITIES** + Manages staff responsible for the submission/resolution of member and provider inquiries, appeals and grievances for the ... requirements. + Maintains call tracking system of correspondence and outcomes for provider and member appeals / grievances ; oversees monitoring of each… more
- CareFirst (Baltimore, MD)
- …mandates. Directs the activities and serves as a resource for associates within the Appeals and Grievances Department for Government Programs. We are looking for ... training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in...data related to the volume and complexity of the appeals and grievances submitted for resolution. **SUPERVISORY… more
- Elevance Health (Atlanta, GA)
- …will make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or retrospective ... Director for final review and decision. + Ensures that appeals and grievances are resolved timely to...or any combination of education and experience, which would provide an equivalent background. + Current active unrestricted RN… more
- Elevance Health (Charlotte, NC)
- …providers, and regulatory entities, and serves as a subject matter expert for appeals , grievances , and quality of care issues. + Key responsibilities: serves ... **Nurse Appeals - Litigation & Legal Support** **Location:** North...or any combination of education and experience, which would provide an equivalent background. + Current active unrestricted RN… more
- Molina Healthcare (AZ)
- …+ Deep understanding of claims lifecycle, EDI transactions, payment integrity, provider data, appeals / grievances , and audit/compliance (CMS, HIPAA, ... management with direct impact on Claims Operations (adjudication, configuration, appeals / grievances , payment integrity, provider data). **Preferred… more
- Fallon Health (Worcester, MA)
- … and grievances addressed to the Member Appeals & Grievances Department. This position will also provide administrative support to the department. ... of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and… more
- Insight Global (Mayfield Heights, OH)
- …Authorization/Gold Carding, Eligibility/Benefits Verification, Claim Submission, Adjudication, Payment, Appeals / Grievances ) * Clear and confident communicator, ... standards and procedures, and prioritize them for assigned areas * Provide guidance, recommendations, and mentor other business analysts on approach, guidance,… more
- LA Care Health Plan (Los Angeles, CA)
- …Functional knowledge of Membership Eligibility and Enrollment, Member Maintenance, PCP assignment, Appeals and Grievances preferred. EDI 5 years of EDI Domain ... Technical Applications Manager II Job Category: Information Technology Department: IT...public agency created by the state of California to provide health coverage to low-income Los Angeles County residents.… more
- Transdev (Dorchester, MA)
- …and governmental laws and regulations. + Manage the grievance process and provide comprehensive responses to complaints, grievances , and arbitrations that ... Transdev in Boston, MA is seeking a Labor Relations Manager for its Boston Public Schools transportation contract. The...policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal… more