• Supervisor , Appeals

    Centene Corporation (Sacramento, CA)
    …in California **Healthcare lead experience with claims, appeals , and grievance strongly preferred.** **Position Purpose:** The Supervisor of Appeals ... accountable for the recruitment, hiring, promotion, counseling, and daily supervision of Grievance and Appeals Specialists and administrative support as they… more
    Centene Corporation (03/14/25)
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  • Appeals and Grievance Analyst

    Point32Health (TX)
    … and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and ... compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with… more
    Point32Health (03/08/25)
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  • Coord Appeals & Grievances

    AmeriHealth Caritas (Philadelphia, PA)
    …Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor , Appeals and Grievances, this position is responsible for ... management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of...files to other teams as needed (eg legal, external appeals , state fair hearings, etc.) + Communicates… more
    AmeriHealth Caritas (03/11/25)
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  • Lead Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    …Grievances is responsible for assisting with the development of a successful and cohesive Appeals and Grievance unit, with a high level of productivity to ... Plan is an independent public agency created by the state of California to provide health coverage to low-income...satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring… more
    LA Care Health Plan (12/19/24)
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  • Appeals & Grievances Program Advisor

    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 ... State Regulations. Complete individual summary scorecards for ...operations. + Act as a CCA content expert on State and Federal Grievance and Appeal regulations… more
    Commonwealth Care Alliance (01/24/25)
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  • Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    …and regulations. Duties Identifies, investigates, and resolves administrative complaints, complex provider appeals and State Fair Hearing adhering to CMS, DHCS, ... Customer Solution Center Appeals and Grievances Specialist II Job Category: Administrative,...Plan is an independent public agency created by the state of California to provide health coverage to low-income… more
    LA Care Health Plan (02/07/25)
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  • Supervisor , Authorization Technician

    LA Care Health Plan (Los Angeles, CA)
    Supervisor , Authorization Technician Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... 1997, LA Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents.… more
    LA Care Health Plan (01/25/25)
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  • Appeal Analyst Pharmacy Medicare

    Corewell Health (Grand Rapids, MI)
    …experience Extensive knowledge of CMS regulations and process + Previous experience with grievance and appeals processes About Corewell Health As a team member ... Ensure favorable decisions are properly effectuated. Assist the Lead and/or Supervisor in coordinating activities and in the development/collection of materials… more
    Corewell Health (03/14/25)
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  • Clinical Assessment Manager (Brooklyn or Staten…

    VNS Health (Manhattan, NY)
    …eligibility. + Coordinates with other departments, eg Care Management, Legal Affairs, Grievance and Appeals , Compliance, Membership Eligibility Unit, Quality as ... with VNS Health Plans policies as well as applicable state and federal regulations. Works under general supervision. Compensation...a safe member centered service plan + Consult with supervisor and others in overcoming barriers in meeting goals… more
    VNS Health (03/04/25)
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  • Spanish Interpreter

    City of New York (New York, NY)
    …Tenancy-related Applications to Re-open Defaults, Removal of Permanent Exclusion and Blatch), Grievance , Applicant Appeals and Trespass cases and Guardian Ad ... officials, internal staff and members of the public. Federal, State , and City mandates require language assistance services to...employees and provide weekly and monthly Kronos reports to Supervisor in the absence of the OIH timekeeper. -… more
    City of New York (02/12/25)
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