- UCLA Health (Los Angeles, CA)
- …of the tracking and trending of all Health Plan initiated grievances and appeals received within the Quality Management department. This position will ... shared email inbox and fax portal of received complaints, appeals and grievances . The management ...all issues that have been addressed. + Consistently maintains quality standards in accordance with department policy. + Completes… more
- Point32Health (Canton, MA)
- …department processes as requested from management ; note trends in Member Appeals and Grievances and notify supervisors of their findings and ensuring ... our communities. At Point32Health, we are building on the quality , nonprofit heritage of our founding organizations, Tufts Health...management as appropriate. + Reviews and appropriately classifies grievances and appeals + Track and ensure… more
- AmeriHealth Caritas (Philadelphia, PA)
- …department, as necessary, for clarification and supporting documentation by escalating issues to appeals and grievances management + Obtain authorization for ... more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the… more
- Point32Health (MA)
- …**Job Summary** Under the direction of the A&G Manager, the Appeals & Grievances QA Auditor audits the quality of letters and keyed entries from the ... 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)
- Lead Customer Solution Center Appeals and Grievances Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances ... purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting...recommends enhancements to process and procedures. Work closely with management to review performance and quality standards… more
- LA Care Health Plan (Los Angeles, CA)
- …Skills Required: Knowledge of state, federal and regulatory requirements in Appeals /Care/Case/Utilization Management / Quality . Strong verbal and written ... Supervisor, Appeals and Grievances Clinical Operations RN...Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and… more
- Point32Health (MA)
- …out their responsibilities. + Coach, develop, and mentor staff in the accurate and timely management of Appeals and Grievances . + Partner with the Appeals ... our communities. At Point32Health, we are building on the quality , nonprofit heritage of our founding organizations, Tufts Health...Under the general direction of the Senior Manager of Appeals and Grievances the Appeals … more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered… 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...and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of… more
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