- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and ... of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.… more
- Molina Healthcare (Spokane, WA)
- Molina Healthcare is hiring for an Appeals & Grievance Specialist . This role is 100% remote and will work in the Pacific Time Zone. This role provides ... appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. + Requests and reviews medical records, notes, and/or… more
- BayCare Health System (Clearwater, FL)
- …be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist -Health Plan **Location** Clearwater:Park Place | ... and medical records. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring all necessary documentation… more
- State of Colorado (Colorado Springs, CO)
- CDOC - Liaison III (Step 3 Grievance Responder) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123844) Apply CDOC - Liaison III (Step 3 ... Grievance Responder) Salary $4,906.00 - $7,849.00 Monthly Location Colorado...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Molina Healthcare (MI)
- …claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, ... **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and… more
- Molina Healthcare (Orem, UT)
- …+ 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
- LA Care Health Plan (Los Angeles, CA)
- …track all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals ... Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the… more
- LA Care Health Plan (Los Angeles, CA)
- …remedial training to CSC staff on identified areas of improvement, such as Appeals and Grievance processes, Claims, etc. Through various delivery methods that ... Customer Solution Center Training Specialist II Job Category: Administrative, HR, Business Professionals...II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017… more
- Cedars-Sinai (CA)
- …CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc. + Remains updated ... **Job Description** The Managed Care Compliance Specialist is responsible for assisting with the implementation...ID** : 11981 **Working Title** : Managed Care Compliance Specialist - Managed Care **Department** : MNS Managed Care… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …referrals generated to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department ... Depending on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of the programs of Utilization… more
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