Appeals and Grievances Coordinator 24-83

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FLSA Status: Exempt Department: Grievance & Appeals Reports To: Director, Operations GENERAL DESCRIPTION OF POSITION The Manager, Grievance & Appeals is the primary point person responsible for the development and management of all grievance and appeal related activities and for providing a positive and professional experience for members and providers...

Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests. In some cases may be combined with Grievance Coordinator functions. - Maintains a caseload and monitors day to day compliance of appeal decision time frames. - Reviews clinical and medical records for completeness and...

Coordinates grievance process as assigned, attends to risk management issues associated with case management and processes grievance requests. Performs outreach contact and written notification with members with resolution to Grievances. Consults with internal departments, to ensure Grievances resolutions meet all guidelines and result in customer...

Coordinates grievance process as assigned, attends to risk management issues associated with case management and processes grievance requests.Performs outreach contact and written notification with members with resolution to Grievances.Consults with internal departments, to ensure Grievances resolutions meet all guidelines and result in customer...

Majority remote - Estimated MINIMUM 5 business days department orientation & training are REQUIRED (non-negotiable) on-site at Mission Bay. Will need to work on-site if internet/power connections prevent effective completion of work, remotely. Strong skills to resolve patient or customer issues. direct experience with managing grievances, or case work...

Thursday, May 23, 2024Position Summary:Under the supervision of the Quality Assurance Supervisor lead by the Quality Manager, assist in all activities related to the PACE (Program of All-Inclusive Care for the Elderly) Quality Management Program. The Quality Assurance Coordinator will be responsible for data collection, management and data submission in...

Thursday, May 23, 2024 Position Summary: Under the supervision of the Quality Assurance Supervisor lead by the Quality Manager, assist in all activities related to the PACE (Program of All-Inclusive Care for the Elderly) Quality Management Program. The Quality Assurance Coordinator will be responsible for data collection, management and data submission in...

Job DescriptionJob DescriptionAs a member of the Population Health and Quality department, the Quality Review Nurse (QRN) will support key clinical quality initiatives at San Francisco Health Plan (SFHP). The QRN is part of SFHP Health Services department which includes Population Health and Quality activities of the Plan. The QRN supports and leads clinical...

Donor Network West's mission is to save and heal lives through organ and tissue donation for transplantation and research. At Donor Network West, we're looking for people who embody our core values: passion, excellence, equity and inclusion, and relationships. We welcome diverse perspectives and foster an environment of collaboration and service.POSITION...

Job DescriptionJob DescriptionEmpowering Wellness, Transforming LivesOptima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and all of its divisions: Serene Health, A Positive Choice, and PsycHealth, our mission is to provide comprehensive support and care that not only addresses immediate concerns...

This Supervisory Human Resources Specialist position is located at San Diego International Airport, Lindbergh Field (SAN), Transportation Security Administration, Department of Homeland Security (DHS). Duties include but are not limited to: Functions as the airport subject matter expert (SME) on human capital core functions to ensure compliance with the...

Position Type: Administration/Coordinator Date Posted: 1/31/2024 Location: Pleasanton ISD District: ESC Region 20 - website Pleasanton ISD: Transition Coordinator (24-25)Primary Purpose: Responsible for identifying, developing, and coordinating resources at each campus assigned in order to meet the needs of students who qualify for special education....

This Supervisory Human Resources Specialist position is located at San Diego International Airport, Lindbergh Field (SAN), Transportation Security Administration, Department of Homeland Security (DHS).Duties include but are not limited to:Functions as the airport subject matter expert (SME) on human capital core functions to ensure compliance with the Office...

POSITION SUMMARY/RESPONSIBILITIES The Resolution Coordinator will conduct operational role-based training for all new hires within PBS. This position will assist the Executive Director and Assistant Directors to provide support within several functional working teams; billing, collections, customer service, cash posting and refunds. The Resolution...

Job DescriptionJob DescriptionIntegral Senior Living, proudly part of the Discovery Senior Living family of operating companies, manages care and lifestyle-focused senior living communities. Our company, which was built on our “Culture Keepers,” employees thousands of vital Team Members and is committed to providing a positive work environment and...

Human Resource Partner Hospital Healthcare San Francisco, CA Here are some of the benefits our client offers their clinical partners: Medical insurance Dental insurance Vision insurance Life insurance Long-term disability insurance Short-term disability/extended sick leave Flexible spending accounts Retirement benefits 403(b) or 401(k) Paid Leave Paid time...

Job DescriptionJob DescriptionThe Rehabilitation Services Coordinator is responsible for the general coordination of multidisciplinary evaluations and pre-admission, program participation and transition planning for patients in the Functional Restoration Programs. The Rehabilitation Services Coordinator will handle all MDE, and FRP authorization requests,...

Job DescriptionJob DescriptionThe Rehabilitation Services Coordinator is responsible for the general coordination of multidisciplinary evaluations and pre-admission, program participation and transition planning for patients in the Functional Restoration Programs. The Rehabilitation Services Coordinator will handle all MDE, and FRP authorization requests,...

Job DescriptionJob DescriptionIntegral Senior Living, proudly part of the Discovery Senior Living family of operating companies, manages care and lifestyle-focused senior living communities. Our company, which was built on our “Culture Keepers,” employees thousands of vital Team Members and is committed to providing a positive work environment and...