- Evolent (Sacramento, CA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The ** Coordinator , Appeals and Grievances ** at Evolent is responsible for reviewing ... prior authorization experience. This role is distinct from other coordinator positions in that it is dedicated to case...required. + Minimum of 3 years' experience in an Appeals and Grievances role or comparable administrative… more
- CVS Health (Sacramento, CA)
- …quality measures, with respect to letter content and turn-around time for appeals , complaints and grievances handling. -Independently researches and translates ... PST Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may… more
- TEKsystems (Long Beach, CA)
- …structure and maintains current and additional information as it relates to Grievances and Appeals services. Utilizes department desktop procedures, workflows, ... High School Diploma, Required 2 years of experience within grievances and appeals in a healthcare setting Experience Level Expert Level #westpriority25… more
- Cedars-Sinai (Beverly Hills, CA)
- …the payor + Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate ... About What You Will be Doing** The RN Care Coordinator is responsible for the case management of patient...the Inpatient Specialty Program (ISP) hospitalists, the RN Care Coordinator will assist patients from the time they are… more
- Highmark Health (Sacramento, CA)
- …through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical ... staff. + Other duties as assigned or requested. **QUALIFICATIONS:** **Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + Pharmacy technician certification… more
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more