- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... grievance process that meets state, federal, accreditation and other...knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests,… more
- Molina Healthcare (New Haven, CT)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance … more
- Commonwealth Care Alliance (Boston, MA)
- …& Responsibilities:** + Conduct monthly case review of a random sample of appeals and grievance cases against previously developed scorecard and Federal and ... 011540 CCA- Appeals & Grievances **Position Summary:** Appeals ...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- Maryland Department of Transportation (Baltimore City County, MD)
- Labor Relations Specialist (Administrator III) Salary $69,323.00 - $112,044.00 Annually Location Baltimore City Job Type Full Time Job Number 2588-MTA-02/25-MS ... + Description + Benefits Description MARYLAND TRANSIT ADMINISTRATION Labor Relations Specialist (Administrator III) (2588) Career Service Open to all qualified… more
- Navy Exchange Services (NEX) (Virginia Beach, VA)
- Title: Labor/Employee Relations Specialist I/ II/ III (Non-competitive Progression) Location: United States-Virginia-Virginia Beach Job Number: 250000Q1 Note: This ... Summary: Under the guidance and supervision of a Labor/Employee Relations Specialist or Labor/Employee Relations Manager, responsible for providing technical support… more
- Tufts Medicine (Boston, MA)
- …involving a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee ... union contract administration including the investigation of grievances, drafting grievance responses, MOA preparation. 6. Coordinates and prepares information for… more
- Louisiana Department of State Civil Service (New Orleans, LA)
- Human Resource Specialist Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4926360) Apply Human Resource Specialist Salary $4,099.00 - ... This position provides direct supervision over the Training and Development Specialist 2 and has functional supervision over an HR Administrative Coordinator… more
- Healthfirst (NY)
- …stakeholders (including, but not limited to Regulatory, Claims Configuration, Provider Ops, Appeals & Grievance , Medical Management, Enrollment & Billing, Sales) ... to identify, scope and accurately implement new benefits, services, or other product changes, update processes and/or edit systems to accommodate regulatory requirements + Assist with ad hoc projects such as focus group studies, process improvement initiatives… more
- City and County of San Francisco (San Francisco, CA)
- …discrimination complaints filed by Airport guests in accordance with federal grievance procedures; serves as a community liaison; evaluates and inspects facilities ... a related field. + Possession of a Certified Access Specialist (CASp) certification in good standing with the California...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- Johns Hopkins University (Baltimore, MD)
- …actions and make sound recommendations to management. + Manage the grievance process, including fact finding, reviewing evidence, serving as hearing officer, ... as an advisor to employees and management on employee appeal and grievance issues. + Work in partnership with department management regarding appropriate… more
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