- Commonwealth Care Alliance (Boston, MA)
- …Reporting to the Director of Appeals & Grievances , the Manager , Appeals & Grievances (A&G) Audit and Oversight is responsible for the oversight ... grievances within the Appeals & Grievances Department and delegated entities. The manager ...+ Leads and represents Member Appeals and Grievances -relatedexternal CMS audits, NCQA Standards, state audit … 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 ... the day to day activities for staff handling of grievances and appeals for one of the...processes and timeframes. Maintains readiness for DOH or CMS audit at all times. + Ensures regulatory compliance and… more
- Fallon Health (Worcester, MA)
- …summary of purpose:** With general direction from the Director of Quality, the Program Manager , Accreditation & Audit ensures that the health plan is compliant ... that support the requirements. + Acts as the project manager for accreditation and audit activities +...quality improvement, credentialing, member rights, utilization management, including member appeals and grievances to support them in… more
- Medical Mutual of Ohio (OH)
- …new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances , and Medicare marketing material requirements. . Assists ... Specialists in the research and review of Part D and Part B inquiries, grievances , and CTMs, updating tracking documents, audit research items, and marketing… more
- Point32Health (Canton, MA)
- …action plans; and working collaboratively with other departments such as Appeals and Grievances , Pharmacy, Customer Relations, the Corporate Compliance ... an " audit ready" department culture. Collaborate with department Senior Manager & Team Managers, Corporate Compliance and other departments to coordinate… more
- Washington Metropolitan Area Transit Authority (Washington, DC)
- Contract Manager Job ID: 240287 Location: DC - L'Enfant Plaza Full/Part Time: Full-Time Posting Open-Close 09/10/2024 - 09/24/2024 Union NRP Regular/Temporary: ... the National Contract Management Association (NCMA), the Certified Professional Contracts Manager (CPCM) or an appropriate certificate from a program sponsored by… more
- Point32Health (MA)
- …and accreditation requirements for Care Management, Utilization Management, and / or Member Appeals and Grievances in a health plan setting preferred **Skill ... click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Program Manager is a Registered Nurse who performs program oversight activities… more
- LA Care Health Plan (Los Angeles, CA)
- …care setting. Experience in health care auditing and monitoring (preferably in Appeals , Grievances , Quality Improvement, Utilization Management (UM) and so ... Compliance unit, the Advisor also advises and supports the Manager , Director, and Chief Compliance Officer on other duties...forth) and developing audit tools. Demonstrated experience developing and delivering training programs… more