- Elevance Health (KS)
- ** Grievance and Appeals Program ...Program Manager, Senior** will be responsible for managing Provider Grievances, Provider Appeals , and ... experience; or any combination of education and experience which would provide an equivalent background. **Preferred Skills, Capabilities and Experiences:** +… more
- LA Care Health Plan (Los Angeles, CA)
- …Grievances Nurse Specialist LVN II is primarily responsible for the overall coordination of the Appeals & Grievance (A&G) program for LA Care Health Plan ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....and appeals . Responsible for handling member and provider appeals providing clinical reviews and write-ups… more
- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our ... grievance and appeals processes. You will play a crucial role in...CMS and Department of Insurance. + Manages specialty subcontractors program for delegated grievance and appeal responsibilities.… more
- Point32Health (VA)
- …here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- Elevance Health (Atlanta, GA)
- …and plan risk, ensures quality, and regulatory compliance.** PRIMARY DUTIES: + Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings. + ... Leads grievance and appeals in regulated audits. +...a resource for complex issues and interpretation of claims, provider contracts and data, eligibility, member contracts, benefits, clinical… more
- Elevance Health (Independence, OH)
- **Manager II - Grievances & Appeals -** ** Provider Disputes** **Location:** This position will work a hybrid model (in office 1-2 days per week). The ideal ... quality, and regulatory compliance. **How you will make an impact:** + Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings. + Leads… more
- CVS Health (Richmond, VA)
- …initiation of appeal process. -Identify and research all components within member or provider /practitioner appeals , complaints and grievance for all products ... affordable. **Position Summary** Coordinate effective resolution of member and/or provider /practitioner appeals , complaints and grievances. Responsible for the… more
- 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 ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring… more
- CareFirst (Baltimore, MD)
- …+ BS/MSN Degree. + 3 years supervisory experience Utilization Management, and Government Program experience with Appeals and Grievance , Experience with MCG, ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate implementation of the clinical appeal process for… more
- LA Care Health Plan (Los Angeles, CA)
- …laws and regulations. Duties Identifies, investigates, and resolves administrative complaints, complex provider appeals and State Fair Hearing adhering to CMS, ... Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints and appeals exercising strong independent judgment. This… more