- CVS Health (Austin, TX)
- …care more personal, convenient and affordable. **Position Summary** As our Medicaid Grievance & Appeals Business Consultant you will develop and ... major projects and functional groups. You will help our business units - and our company - meet corporate...practice transfer **Required Qualifications** + 3 to 5 years Grievance and Appeals experience + Experience with… more
- Elevance Health (Olathe, KS)
- **Provider Grievance and Appeals - Business Change Advisor** **Location: Topeka KS, or Olathe, KS** This position will work a hybrid model (remote and ... 50 miles of one of our Kansas Elevance Health PulsePoint locations. The **Provider Grievance and Appeals - Business Change Advisor** is responsible for… more
- Elevance Health (Los Angeles, CA)
- **Manager II Grievance / Appeals - Claims Support** This position will work in a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The **Manager II Grievance / Appeals ** is responsible for management oversight of grievances and appeals departmental units to… more
- Henry Ford Health System (Troy, MI)
- …Plan's (HAP's): Commercial, Medicare Advantage, Medicare- Medicaid Program (MMP), and Medicaid lines of business . Analyst must identify trending issues on ... AND RESPONSIBILITIES:\ + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center for … more
- CVS Health (Trenton, NJ)
- …obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. Coordinates provider status information ... health care more personal, convenient and affordable. **Position Summary** + The Medicaid VBS Network State Manager manages and oversees compliance with our Network… more
- CVS Health (Dallas, TX)
- …Company functions that may require travel as necessary. * Participates in weekly Grievance and Appeals meetings, tracks and trends provider grievances, monitors ... obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. Coordinates provider status information… more
- Humana (Hartford, CT)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease...member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors… more
- Humana (Augusta, ME)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease...member population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- Highmark Health (Dover, DE)
- …This position is also responsible for assisting members in navigating the grievance and appeals process and representing member interests internally and ... Service **Preferred** + Familiarity as a Member Advocate or with complaint and grievance processes + Familiarity with Delaware Medicaid and the Medicaid… more
- The Cigna Group (Bloomfield, CT)
- …with every other weekend (Tuesday ALT Day).** + Must have experience in Medicare Appeals , Utilization Case Management or Compliance in Medicare Part C + Ability to ... differentiate different types of requests Appeals , Grievances, coverage determination and Organization Determinations in order to ensure the correct processing of… more