- Molina Healthcare (Buffalo, NY)
- …Manages staff responsible for the submission/resolution of member and provider inquiries, appeals and grievances for the Plan. Ensures resolutions are compliant. ... tracking system of correspondence and outcomes for provider and member appeals / grievances ; oversees monitoring of each member submission/resolution to ensure… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances ... net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G)...appeals issues, preferably in a managed care or Medicaid Health Plan environment and/or public services or public… more
- Molina Healthcare (Kenosha, WI)
- …Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and ... or as directed by the Centers for Medicare and Medicaid Services. * Trains grievance and appeals ... and grievance processing/resolution, including 2 years in a manager role. * Experience reviewing all types of medical… more
- CareFirst (Baltimore, MD)
- …mandates. Directs the activities and serves as a resource for associates within the Appeals and Grievances Department for Government Programs. We are looking for ... training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in...data related to the volume and complexity of the appeals and grievances submitted for resolution. **SUPERVISORY… 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 ... the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the...assigning all incoming appeals and grievances… more
- Molina Healthcare (Akron, OH)
- …to remediate immediate and acute gaps in care and access. Assist members with filing grievances and appeals . + Connects members to CCEs, the Ohio RISE Plan,or ... you will also work on telephonic population health initiatives such as supporting Medicaid members that have a waiver, making outreach to Medicaid members… more
- Molina Healthcare (San Jose, CA)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
- Commonwealth Care Alliance (Boston, MA)
- …and supports, and community supports as approved + Supports escalation of member grievances and appeals + Supports the procurement of network providers and ... across various locations. This position reports to the CIC APC Clinical Manager . **Supervision Exercised:** No, this position does not have direct reports.… more