- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... verified through reconciliation of end to end on all regulatory functions. Duties Audit readiness: Performs ...Required: A minimum of 5 years of experience in regulatory auditing ( Appeals & Grievances ,… more
- Dignity Health (Bakersfield, CA)
- …managed care experience preferred - 1 years delegation oversight experience preferred - Regulatory audit experience preferred - Bachelor's degree in a relevant ... position is remote/work from home** **within California** **.** **Position Summary:** The Appeals and Grievances Coordinator is responsible for managing and… more
- Point32Health (MA)
- …colleagues and communities. **Job Summary** Under the direction of the A&G Manager, the Appeals & Grievances QA Auditor audits the quality of letters and keyed ... audit findings and identifies areas of opportunity for the A&G ( Appeals and Grievances ) department. Understands department, segment, organizational strategy… more
- 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...audit . + Participate in data quality checks for regulatory reporting submissions by verifying data in Guiding Care… more
- Molina Healthcare (TX)
- …integrated, proactive HCS management, ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina Clinical ... population, and triage activities. + Ensures completion of staff quality audit reviews. Evaluates services provided and outcomes achieved and recommends… more
- VNS Health (Manhattan, NY)
- …meet our high standards for operational and regulatory compliance in managing grievances and appeals on our behalf. * Data-Driven Decisions: Maintain the ... Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long...processes and timeframes. Maintains readiness for DOH or CMS audit at all times. + Ensures regulatory … more
- Corewell Health (Grand Rapids, MI)
- …to date with regulatory , departmental, and organizational changes impacting the appeals and grievances processes. + Supervise the day-to-day operations of ... + Ensure that the Appeals & Grievance department processes all appeals , grievances , and complaints in accordance with standards and the organization's… more
- Baylor Scott & White Health (Temple, TX)
- … Appeals and Grievance Coordinator is responsible for intake into the Appeals and Grievances Department, including verbal and written complaints, ... grievances and requests for appeals that involve complex matters submitted by Members and...in writing. + Maintains required documentation to assure meeting regulatory requirements on intake processes (eg acknowledgement letters; waiver… more
- CVS Health (Tampa, FL)
- …delivering exceptional outcomes. This leader will oversee the precertification process, grievances and appeals management, turnaround time (TAT) adherence, and ... and member outcomes. + Driving strategic initiatives to enhance UM processes, minimizing grievances and appeals , and ensuring compliance with all state, federal,… more
- LA Care Health Plan (Los Angeles, CA)
- …due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters to ... the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an accurate database inventory of referral… more