- Robert Half Accountemps (Los Angeles, CA)
- Description A Medical IPA Company in Mid-Wilshire is seeking a dedicated and detail-oriented Grievance and Appeals Specialist to join our team. The ideal ... organizational efficiency. Requirements + Minimum 2-3 years of experience in grievance and appeals handling, case management, or a similar role within a… more
- VNS Health (Manhattan, NY)
- …criteria. + Enters data and assists with compiling reports and analysis on the grievance and appeals process. + Participates in special projects and performs ... experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required +… more
- Elevance Health (San Antonio, TX)
- …and personalized support throughout the consumer's treatment journey. **Title:** Grievance / Appeals Representative II **Location:** Onsite at TX-SAN ANTONIO, ... Health location. **Build the Possibilities. Make an extraordinary impact.** The Grievance / Appeals Representative II is responsible for reviewing, analyzing and… more
- BayCare Health System (Clearwater, FL)
- …must reside in Florida Equal Opportunity Employer Veterans/Disabled **Position** Intake Specialist Appeal and Grievance - Health Plan **Location** ... and clinical excellence. **Summary:** + Handles and processes customer appeals and grievances in accordance with established guidelines, company policies,… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... grievance process that meets state, federal, accreditation and other...knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests,… more
- Molina Healthcare (Owensboro, KY)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance … more
- Commonwealth Care Alliance (Boston, MA)
- …& Responsibilities:** + Conduct monthly case review of a random sample of appeals and grievance cases against previously developed scorecard and Federal and ... 011540 CCA- Appeals & Grievances **Position Summary:** Appeals ...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- LA Care Health Plan (Los Angeles, CA)
- …remedial training to CSC staff on identified areas of improvement, such as Appeals and Grievance processes, Claims, etc. Through various delivery methods that ... Customer Solution Center Training Specialist II Job Category: Customer Service Department: CSC...that purpose. Job Summary The Customer Solution Center Training Specialist II is responsible for conducting functional training Customer… more
- Loretto Management Corporation (Syracuse, NY)
- …deems the equipment is no longer necessary. + Responsible for explaining PACE CNY's grievance and appeals process to participants. + Repairs any broken DME, ... Overview The Durable Medical Equipment (DME) Specialist assists DME Manager in the daily operations...preventative maintenance, cleaning and repair of DME. The DME Specialist assists with the DME inventory as needed. Promotes… more