- Point32Health (MA)
- …members, partners, colleagues and communities. **Job Summary** Under the direction of the A&G Manager , the Appeals & Grievances QA Auditor audits the quality ... audit findings and identifies areas of opportunity for the A&G ( Appeals and Grievances ) department. Understands department, segment, organizational strategy… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN...culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the A&G Leadership in… more
- Molina Healthcare (TX)
- …of illness and the site of service. **KNOWLEDGE/SKILLS/ABILITIES** The Manager , Healthcare Services provides operational management and oversight of integrated ... members. Oversees Interdisciplinary Care Team meetings. + Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare… more
- VNS Health (Manhattan, NY)
- …Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances . + Ensures the accuracy and integrity of data ... of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals (RN)to lead the...Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long… more
- Centene Corporation (Indianapolis, IN)
- …Coordinators. + Ensure that the Grievance and Appeals department processes all appeals and grievances in accordance with referred time frames and other ... contractual legal requirements + Monitor appeals and grievances and provide senior management with monthly reporting on trends + Ensure that all members and… more
- Elevance Health (Richmond, VA)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, ... an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Las Vegas, NV)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, ... an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Centene Corporation (Austin, TX)
- …ONLY Appeals Experience HIGHLY Preferred **Position Purpose:** The Supervisor of Appeals & Grievances is accountable for the recruitment, hiring, promotion, ... in necessary skills and knowledge base and will assist Manager of Grievance and Appeals to establish... Unit members. + Continually trains Unit members concerning grievances , appeals , and provider disputes/ appeals .… more
- Elevance Health (Norfolk, VA)
- …locations. Expected Work Hours: Monday-Friday; 8AM-5PM EST The ** Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and ... ** Manager II Grievance/ Appeals (RN)- Claims Support**...departmental units to investigate, resolve, and respond to client/provider grievances / appeals and ensure compliance with regulatory requirements.… more
- Elevance Health (Cincinnati, OH)
- …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