- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances ... support the safety net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General Operations (Clinical) is responsible… more
- Molina Healthcare (Houston, TX)
- …* Manages team responsible for the submission/resolution of member and provider appeals and grievances ; ensures resolutions are compliant with applicable ... call tracking system of correspondence and outcomes for provider and member appeals / grievances ; oversees/monitors appeals to ensure all internal and… more
- Fallon Health (Worcester, MA)
- …other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH ... standards. The Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals &… more
- Elevance Health (South Portland, ME)
- …analyzing and processing non-complex and some complex pre service and post service grievances and appeals requests in the Enterprise Grievance & Appeals ... + The analyst may serve as a liaison between grievances & appeals and /or medical management,...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CareFirst (Baltimore, MD)
- …educational and training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in the development and ... data related to the volume and complexity of the appeals and grievances submitted for resolution. **SUPERVISORY...Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred + LNCC - Legal Nurse… more
- Molina Healthcare (AZ)
- …Design scalable workflows and controls across intake, adjudication, adjustments, appeals / grievances , and payment integrity. + Technology Enablement: Oversee ... understanding of claims lifecycle, EDI transactions, payment integrity, provider data, appeals / grievances , and audit/compliance (CMS, HIPAA, NCQA, state regs). +… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances...clerical/administrative responsibilities at the discretion of the Director or Manager . * Providing administrative assistance in support of the… more
- Elevance Health (Washington, DC)
- …locating services and maintaining eligibility in a timely fashion, resolving Enrollee Grievances , assisting Enrollees to file and pursue Appeals involving the ... be familiar with Salesforce + Experience with Tableau strongly preferred + Grievances and appeals experience strongly preferred + Enrollee Services experience… more
- State of Colorado (Pueblo, CO)
- Relief Pool and Ambulatory Clinic Manager - Mid Level Provider - CMHHIP Nursing- Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5137227) ... Apply Relief Pool and Ambulatory Clinic Manager - Mid Level Provider - CMHHIP Nursing- Pueblo...actions, signing performance plans and appraisals, and resolving informal grievances at the lowest level. + Draft and deliver… more
- Transdev (Dorchester, MA)
- …of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal requirements and ... Overview: Transdev in Boston, MA is seeking a Labor Relations Manager for its Boston Public Schools transportation contract. The Labor Relations Manager provides… more
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