• Appeals and Grievances…

    Commonwealth Care Alliance (Boston, MA)
    011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance ... of the Appeals and Grievances department through many NCQA... department through many NCQA and other related quality program activities including: monthly case quality monitoring, coordination of… more
    Commonwealth Care Alliance (09/05/25)
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  • AA*Medical Director Physician Advisor UM

    AdventHealth (Altamonte Springs, FL)
    …and making recommendations on appealed provider claims and makes determinations for appeals and grievances from patients; assists in drafting and submitting ... : Altamonte Springs, FL **The role you will contribute:** The Physician Advisor provides primary support for Utilization Management (UM) and secondary support for… more
    AdventHealth (08/07/25)
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  • Medical Director - Sharp Health Plan - Hybrid…

    Sharp HealthCare (San Diego, CA)
    …policy as needed. + Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify trends ... the membership. Serves as a medical manager and policy advisor to SHP and its Chief Medical Officer. Is...plan Chief Medical Officer) in short and long range program planning, total quality management (quality improvement), and external… more
    Sharp HealthCare (08/17/25)
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  • Senior Medical Director - Sharp Health Plan…

    Sharp HealthCare (San Diego, CA)
    …to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify ... of care foundation for our NCQA required population health management program . Additionally, this position provides the representation of physician's insight,… more
    Sharp HealthCare (07/19/25)
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  • Sexual Assault Response Coordinator (SARC) - Title…

    Air National Guard Units (Garden City, GA)
    …simple, informal complaints from SAPR VAs and refer other complaints, such as formal grievances and appeals , to the Supervisory Principal SARC or an appropriate ... in the community as assigned by the Supervisory Principal SARC. Assist in program evaluation and improvement initiatives by providing feedback and suggestions to the… more
    Air National Guard Units (09/10/25)
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  • Human Resources Officer

    Naval Facilities Engineering Command (GU)
    …solving problems. You will administer the employee relations programs, including appeals , discipline, grievances , performance management, incentive awards, and ... Naval Facilities Engineering Command (NAVFAC) Marianas. You will serve as the senior advisor for all Civilian Human Resources (CHR) policy and service delivery for… more
    Naval Facilities Engineering Command (09/07/25)
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