Management is required. Minimum of 5 years in Utilization Management, health care Appeals, compliance and/or grievances.... Stay for the culture. What You’ll Be Doing: The Specialty Appeals Team offers candidates the opportunity to make...
The Manager, Member Resolution will lead a high-impact team within the Grievance & Appeals (G&A) department, overseeing... the resolution of pre-service and post-service member appeals, member-submitted grievances, and appeal requests submitted...
, grievances and appeals as required by regulations, policy and department process standards. Following policy and regulatory... guidance, reviews response and resolution by applicable method to inquiries, grievances and appeals as required by regulations...
is required. Act as the initial investigator and contact person for member grievances and appeals, which includes, sending the...Responsibilities Administer FH Standard and Expedited Appeals Processes as outlined in Member Handbook/Evidence...
Grievance & Appeals Department responsible to review, analyze and process pre service and post service grievances and appeals... to provide review and analysis of complex pre service and post service grievances and appeals requests from customer and multiple...
Responsibilities Job Responsibilities: This position is divided equally between Member Appeals and Grievances... and contact person for grievances and appeals, which includes, sending the appropriate acknowledgment of the grievance/appeal...
, and claim files to “build a case” within the Appeals and Grievances Manager (AGM) tool. Ensure accurate routing of urgent... Executive Services department. Responsible for the review, analysis, prioritizing, and assigning of appeals, grievances...
, grievances, and DOI appeals Respond promptly and accurately to inquiries regarding claim status, coverage, and payment. Gather... and value inside and outside the exam room for all patients. Job Description The Inquiries, Appeals, and Dispute Analyst...
optimize the vision and roadmap for our care management, utilization management, and/or claims, appeals, and grievances... and metrics. The Agile Product Manager, Consultant will report to the Manager of Product Management. In this role you will lead...
Manager, Utilization Manager, and Medical Director) and departments to address and resolve member grievances and appeals... materials Manage the member grievances and appeals process and work closely with other managers (especially, the Quality...
, Law Enforcement). Assists and participates in appeal or fair hearings, member grievances, appeals, and state audits...Anticipated End Date: 2025-05-17 Position Title: LTSS Service Coordinator (Case Manager) Job Description: LTSS...
Job Category: Operations Degree Level: Bachelor's Degree Job Description: The Compliance Manager will perform... upgrades of MHK software solutions when needed for Utilization Management, Care Management, Pharmacy, Medical Appeals...
, Law Enforcement). Assists and participates in appeal or fair hearings, member grievances, appeals, and state audits...Anticipated End Date: 2025-05-15 Position Title: LTSS Service Coordinator - Case Manager (Pasco/Pinellas County...
grievances, appeals, and state audits. Minimum Requirements: Requires BA/BS degree and a minimum of 2 years of experience...Anticipated End Date: 2025-05-15 Position Title: LTSS Service Coordinator - Case Manager (Cape Coral/Ft. Myers...
grievances, appeals, and state audits. Minimum Requirements: Requires BA/BS degree and a minimum of 2 years of experience...Anticipated End Date: 2025-05-15 Position Title: LTSS Service Coordinator - Case Manager (Brevard/Orange/Osceola...
) license through the State of California 2+ years with Appeals and Grievances, Claims or Health Plan Customer Service 2...Optum CA is seeking a Quality Improvement Manager to join our team in El Segundo, CA. Optum is a clinician-led care...
) license through the State of California 2+ years with Appeals and Grievances, Claims or Health Plan Customer Service 2...Optum CA is seeking a Quality Improvement Manager to join our team in El Segundo, CA. Optum is a clinician-led care...
, grievances and appeals received by or applicable to PAS. Participates in Product Development and Sales processes, including...Overview: Claims Manager Health Insurance Policies or Benefits Summary: Premier Administrative Solutions (PAS...
interventions to improve overall member satisfaction, such as grievances and appeals data, CAHPS surveys, Healthcare Effectiveness... Project Manager II is a healthcare project specialist who is responsible for managing day-to-day operations of a portfolio...
Anticipated End Date: 2025-05-05 Position Title: LTSS Service Coordinator - Case Manager Job Description: LTSS... agencies (Adult Protective Services, Law Enforcement). Assists and participates in appeal or fair hearings, member grievances...