Current jobs related to Manager, Appeals and Grievances - Oklahoma City, Oklahoma - Evolent Health

  • Corporate Billing Specialist

    2 weeks ago

    Oklahoma City, Oklahoma, United States Cohesive Healthcare Management Full time

    Job SummaryCohesive Healthcare Management is seeking a highly skilled Corporate Billing Specialist to join our team. This role is responsible for ensuring accurate and timely billing processes within a corporate environment.Key ResponsibilitiesPrepare and submit billing to assigned payors/insurance companiesPrepare deposits; distribute/post payments for...

  • Project Manager EQRO

    2 weeks ago

    Oklahoma City, Oklahoma, United States Health Services Advisory Group Full time

    Job SummaryThe Project Manager will be responsible for monitoring and supporting Health Services Advisory Group's (HSAG) compliance with State external quality review (EQR) contracts. This includes compliance reviews, readiness reviews, and contributing to the development of annual technical reports and quality strategies.Key ResponsibilitiesProvide...

  • Nurse Case Manager

    2 weeks ago

    Oklahoma City, Oklahoma, United States United Surgical Partners Full time

    Job SummaryWe are seeking a highly skilled and compassionate Nurse Case Manager to join our team at United Surgical Partners. As a key member of our healthcare team, you will play a vital role in ensuring the highest level of care and service for our patients and their families.Key ResponsibilitiesCollaborate with healthcare professionals to assess, plan,...

  • I&E Engineering Manager

    1 month ago

    Oklahoma City, Oklahoma, United States Affinity Management Group Full time

    Electrical and Instrumentation Engineering ManagerOur client, an EPC company, is seeking an experienced Electrical and Instrumentation Engineering Manager to lead their team. In this role, you will oversee a team of engineers responsible for designing and implementing electrical and instrumentation systems for various projects.Key Responsibilities:Lead a...

  • Property Management Supervisor

    2 weeks ago

    Oklahoma City, Oklahoma, United States Pro Residential Full time

    Property Management Supervisor OpportunityWe are seeking a seasoned Property Management Supervisor to join our team at Pro Residential. As a key member of our property management team, you will be responsible for overseeing the day-to-day operations of our apartment complexes in Oklahoma.Key Responsibilities:Coordinate and manage all transactions, ensuring...

  • Senior Manager

    4 weeks ago

    Oklahoma City, Oklahoma, United States MidFirst Bank Full time

    Job Title: Senior ManagerThe Transaction Management team at MidFirst Bank plays a crucial role in coordinating Onboarding, Sale, Due Diligence, Transfer, and Post-Transfer activities related to portfolios of mortgages and mortgage servicing. As a Senior Manager, you will be responsible for overseeing various aspects of these transactions.Key...

  • Restaurant Operations Manager

    2 weeks ago

    Oklahoma City, Oklahoma, United States Hideaway Pizza Full time

    Job SummaryThe Restaurant Operations Manager is responsible for overseeing the daily operations of the restaurant, including the development and performance of the team. In addition, the Manager works with the GM to oversee the financial management while optimizing profitability. The primary goal is to ensure the restaurant runs efficiently and provides the...

  • RN Case Manager

    1 month ago

    Oklahoma City, Oklahoma, United States Travel Nurse Across America Full time

    Travel Nurse Case Manager Job DescriptionWe're seeking a skilled RN Case Manager to join our team of travel nurses in Oklahoma City, OK. As a RN Case Manager, you'll play a vital role in advocating for patients, evaluating their needs, and developing comprehensive care plans.Key Responsibilities:Evaluate and assess new patients to identify their unique needs...

  • Nurse Case Manager

    2 weeks ago

    Oklahoma City, Oklahoma, United States United Surgical Partners Full time

    Job SummaryWe are seeking a skilled Nurse Case Manager to join our team at United Surgical Partners. As a key member of our healthcare team, you will be responsible for collaborating with patients, families, and healthcare providers to ensure seamless care transitions and optimal health outcomes.Key Responsibilities:Assess patient needs and develop...

  • Nurse Case Manager

    1 week ago

    Oklahoma City, Oklahoma, United States United Surgical Partners Full time

    Job SummaryWe are seeking a skilled Nurse Case Manager to join our team at United Surgical Partners. As a key member of our healthcare team, you will be responsible for collaborating with patients, families, and healthcare providers to ensure the highest level of quality care and service.Key ResponsibilitiesAssess patient needs and develop individualized...

  • Territory Sales Manager

    2 weeks ago

    Oklahoma City, Oklahoma, United States S & K SALES CO Full time

    Job Title: Territory Sales ManagerJob Summary:We are seeking a highly motivated and experienced Territory Sales Manager to join our team at S & K Sales Co. The successful candidate will be responsible for increasing visibility and sales through effective merchandising and demos, ensuring compliance with our Point of Sale (POG) guidelines.Key...

  • Restaurant Operations Manager

    2 weeks ago

    Oklahoma City, Oklahoma, United States Hideaway Pizza Full time

    Job Title: Restaurant Operations ManagerJob SummaryThe Restaurant Operations Manager is responsible for overseeing the daily operations of the restaurant, ensuring a positive experience for guests. This includes developing and performing the team, working with the General Manager to oversee financial management, and optimizing profitability.Key...

  • Nurse Case Manager

    3 weeks ago

    Oklahoma City, Oklahoma, United States United Surgical Partners Full time

    Job SummaryWe are seeking a highly skilled and experienced Nurse Case Manager to join our team at United Surgical Partners. As a key member of our healthcare team, you will be responsible for collaborating with patients, families, and healthcare providers to ensure the highest level of quality care and service.Key ResponsibilitiesCollaborate with patients,...

  • Bakery Department Manager Trainee

    1 week ago

    Oklahoma City, Oklahoma, United States WinCo Foods Full time

    About the RoleAs a key member of the WinCo Foods team, you will play a vital role in ensuring the success of our bakery department. This position offers a unique opportunity to develop your skills and knowledge in a fast-paced retail environment.Key ResponsibilitiesAssist the Bakery Department Manager in directing and controlling the operation of the bakery...

  • Customer Service Representative

    3 weeks ago

    Oklahoma City, Oklahoma, United States Lincare Holdings Full time

    Job SummaryWe are seeking a highly organized and detail-oriented Customer Service Representative to join our team at Lincare Holdings. As a Customer Service Representative, you will be responsible for contacting payers to obtain claims status, follow up on denials, and process incoming and outgoing correspondence.Key ResponsibilitiesClaims Status and...

  • Territory Manager

    1 week ago

    Oklahoma City, Oklahoma, United States Johnson and Johnson Full time

    We are seeking a highly motivated and results-driven Territory Manager to join our team at Johnson & Johnson. As a key member of our sales team, you will be responsible for achieving sales goals and key business metrics in your assigned territory by executing our company's strategies and tactics.Key Responsibilities:Achieve sales goals and key business...

  • Customer Service Representative

    2 weeks ago

    Oklahoma City, Oklahoma, United States Lincare Holdings Full time

    Job SummaryWe are seeking a highly organized and detail-oriented Customer Service Representative to join our team at Lincare Holdings. In this role, you will be responsible for contacting payers to obtain claims status, following up on denials, and processing incoming and outgoing correspondence.Key ResponsibilitiesObtain Payer Requirements: Ensure timely...

  • Visual Merchandising Specialist

    4 weeks ago

    Oklahoma City, Oklahoma, United States Anthropologie Full time

    Job SummaryWe are seeking a highly skilled and creative Visual Merchandising Specialist to join our team at Anthropologie. As a Visual Merchandising Specialist, you will be responsible for creating an emotionally engaging environment that reflects the customer's appreciation of discovery, creativity, diversity, and authenticity.Key...

  • Program Management Practice Leader

    1 month ago

    Oklahoma City, Oklahoma, United States Freese And Nichols Full time

    Freese and Nichols is seeking a seasoned professional to lead our Program Management Practice. As a key member of our team, you will be responsible for developing and implementing strategies to drive business growth and enhance our national expertise in program management.Key Responsibilities:Develop and lead our Program Management Practice, working closely...

  • Program Management Practice Leader

    1 month ago

    Oklahoma City, Oklahoma, United States Freese And Nichols Full time

    Freese and Nichols is seeking a seasoned professional to lead our Program Management Practice. As a key member of our team, you will be responsible for developing and implementing strategies to drive business growth and enhance our national expertise in public sector capital improvement projects.Key Responsibilities:Collaborate with operational groups and...

Manager, Appeals and Grievances

4 months ago

Oklahoma City, Oklahoma, United States Evolent Health Full time

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You'll Be Doing:

The Appeals & Grievances Team offers candidates the opportunity to make a meaningful impact as part of a highly trained dedicated team focusing on Appeals and Grievances submitted by both members and providers. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures while complying with timeliness guidelines. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes for the clients and members we serve.

Collaboration Opportunities:

  • Internal teams: Utilization Management, Claims, Customer Service, Letter Writing, Market Operations, and more.
  • External clients in meetings and to provide their metrics in a meaningful way. We also collaborate with providers as needed.

What You'll Be Doing:

  • Effectively manage a team to ensure a positive team environment:
  • Overseeing daily workflow.
  • Assess workloads and adjust as necessary to ensure work is completed timely and in compliance.
  • Conduct performance reviews to provide feedback and development opportunities.
  • Select, train and orient new team members
  • Monitor productivity of Appeals and Grievance (A&G) coordinators to achieve timely, accurate and thorough resolution of A&G cases, while meeting performance standards and compliance requirements.
  • Perform internal audits and monitor consistency and quality of the team to measure compliance with regulatory and accreditation standards. Participates in external audits, including document preparation and participation in on-site or remote audits, as a subject matter expert.
  • Strict adherence to turn-around times with high-quality documentation in accordance with regulatory standards.
  • Ability to multitask and respond quickly and accurately to issues and concerns for members and internal departments.
  • Compile client reporting and presentation metrics for CCOM and other scheduled meetings, including deep dive into missed metrics and trends.
  • Other duties as assigned by the Director, Appeals & Grievances.
  • Abides by HIPAA regulations and confidentiality requirements; document, research and review member grievances, involving quality of care or quality of service with appropriate clinical and/or other department staff.

The Experience You Need (Required):

  • 3+ years of appeals and grievances experience in a payer-based environment
  • 3+ years of supervisory experience
  • Expertise in Medicaid/Commercial appeals and grievances regulatory requirements
  • Proficiency with PC-based software programs including Word, Excel and Outlook
  • Excellent written and oral communication skills
  • Ability to work remotely and independently

Finishing Touches (Preferred):

  • Experience with fully insured and self-funded LOB including Exchange and ERISA requirements
  • Experienced with CMS and other audits, preferably presenting cases to CMS and other entities
  • Current working knowledge of Utilization Management
  • Medical or claims coding experience
  • Medical claims review experience
  • Experience with or knowledge of claims processing practices
  • Strong critical thinking, analytical, research and organizational skills
  • Knowledge of NCQA and URAC accreditation
  • Knowledge of CMS (Medicare/Medicaid) regulations and requirements
  • Knowledge of Managed Care contracts/guidelines
  • Working knowledge of various reimbursement mechanisms, including third party requirements

Technical Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact for further assistance.

The expected base salary/wage range for this position is $85,000. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit

For more insights about Evolent Health, click on Life At Evolent ) to learn more