• Manager , Grievance & Appeals

    Centene Corporation (Sacramento, CA)
    …Woodland Hills or Natomas offices **Position Purpose:** Ensure appropriate processing of member grievance appeals , provider appeals , or request for a State ... of contact with the State. Manage the day to day responsibilities of the Grievance & Appeals Coordinators. + Ensure that the Grievance and Appeals … more
    Centene Corporation (10/08/25)
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  • Grievance And Appeals Coordinator

    TEKsystems (Long Beach, CA)
    …reside in CA, AZ, TX, NM, or NV JOB PURPOSE: Facilitates the member grievance and appeal process by investigating, documenting and preparing case files to meet all ... regulatory requirements. ESSENTIAL JOB RESULTS: Investigates member grievance and appeal by gathering supporting documentation from internal departments, contracted… more
    TEKsystems (10/08/25)
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  • Registered Nurse (RN) Manager…

    LA Care Health Plan (Los Angeles, CA)
    Registered Nurse (RN) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General...and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best… more
    LA Care Health Plan (09/09/25)
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  • Clinical Appeal and Grievance Nurse

    Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
    …guidelines including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals , Utilization Review, and Grievance processes including benefit interpretation, ... clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal and Grievance Nurse is responsible for conducting daily clinical and benefit… more
    Brighton Health Plan Solutions, LLC (10/05/25)
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  • Director, Appeals & Grievances (Remote)

    Molina Healthcare (Kenosha, WI)
    …7 years experience in healthcare claims review and/or member appeals and grievance processing/resolution, including 2 years in a manager role. * Experience ... Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member… more
    Molina Healthcare (09/26/25)
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  • Customer Solution Center Appeals…

    LA Care Health Plan (Los Angeles, CA)
    …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and cohesive unit with...the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB… more
    LA Care Health Plan (08/29/25)
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  • Grievances and Appeals 3

    CenterWell (Helena, MT)
    …call center or related customer service experience + 1 - 3 years of grievance and appeals experience + Previous experience processing medical claims + Bilingual ... and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by...review of clinical documentation to determine if an a grievance , appeal or further request is warranted and then… more
    CenterWell (10/08/25)
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  • Nurse Appeals RN

    Elevance Health (Atlanta, GA)
    **Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... unless an accommodation is granted as required by law._ The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
    Elevance Health (10/08/25)
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  • Member Intake Admin - Hybrid $22/hr

    Fallon Health (Worcester, MA)
    …us on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH… more
    Fallon Health (08/13/25)
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  • Labor Relations Manager

    Transdev (Dorchester, MA)
    Overview: Transdev in Boston, MA is seeking a Labor Relations Manager for its Boston Public Schools transportation contract. The Labor Relations Manager provides ... Responsibilities: + Manage labor relations program of the property jointly with the General Manager . + Research, compile, and prepare data for use in grievance … more
    Transdev (10/06/25)
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