Appeals and Grievances Manager

Job SummaryThe Appeals and Grievances Supervisor is responsible for leading and directing the work of the Appeals & Grievances department. This includes monitoring research, negotiation, and resolution of appeals and grievances to ensure thorough investigations are completed in accordance with company policies and procedures.Key ResponsibilitiesDirect...

Job SummaryWe are seeking a highly organized and detail-oriented Grievance and Appeals Coordinator to join our team at MedPOINT Management.The successful candidate will be responsible for handling appeals and grievances, researching cases, and resolving issues in a timely and efficient manner.Key ResponsibilitiesHandle appeals and grievances by inputting...

Job Title: Appeals and Grievances SupervisorThe Appeals and Grievances Supervisor plays a critical role in ensuring the efficient resolution of appeals and grievances within the Customer Solution Center. This position involves leading a team of professionals who handle the intake, research, resolution, tracking, and reporting of appeals and grievances.Key...

Job SummaryThe Appeals and Grievances Supervisor is responsible for leading a team that handles appeals and grievances in a healthcare setting. This role involves supervising and supporting team members, monitoring research and resolution of appeals and grievances, and ensuring thorough investigations are completed according to company policies and...

Job Title: Appeals and Grievances SupervisorThe Appeals and Grievances Supervisor is a critical role within the Customer Solution Center, responsible for leading and directing the team that handles appeals and grievances. This position involves monitoring research, negotiation, and resolution of appeals and grievances, ensuring thorough investigations are...

Job SummaryWe are seeking a highly skilled and experienced Manager II Grievance/Appeals to join our team at Elevance Health. As a key member of our Claims Support department, you will be responsible for managing the grievance and appeals process, ensuring compliance with regulatory requirements, and providing exceptional service to our clients and...

Job Title: Appeals and Grievances SupervisorThe Appeals and Grievances Supervisor plays a critical role in ensuring the efficient and effective resolution of appeals and grievances within the healthcare industry. This position requires a strong leader who can supervise and support a team of professionals in handling complex cases, analyzing data, and...

Job DescriptionAt Elevance Health, we are seeking a highly skilled Manager II Grievance/Appeals to join our team. This role will be responsible for managing the grievances and appeals departmental units, ensuring compliance with regulatory requirements, and providing exceptional service to our clients and providers.Key Responsibilities:Maintain and...

Job SummaryWe are seeking a highly skilled Appeals and Grievances Specialist I to join our team at Insight Global. As a key member of our Customer Solution Center, you will play a critical role in receiving, investigating, and resolving member and provider complaints and appeals.Key ResponsibilitiesInvestigate and resolve less complex appeals and grievances...

Job Title: Customer Solutions Center Appeals and Grievances Training Specialist IIAt CCG Business Solutions, LLC, we are seeking a highly skilled and experienced Training Specialist II to join our team. As a key member of our Customer Solutions Center Appeals and Grievances team, you will be responsible for providing ongoing training on the core processing...

Job SummaryElevance Health is seeking a highly skilled Manager II Grievance/Appeals to join our team. As a key member of our Claims Support department, you will be responsible for managing the grievance and appeals process, ensuring compliance with regulatory requirements, and providing exceptional service to our clients and providers.Key...

About the RoleWe are seeking a highly skilled Operations Manager to join our team at Blue Shield of California. As a key member of our Appeals and Grievances team, you will be responsible for leading a team of professionals in resolving member concerns through a regulated process.Key ResponsibilitiesProvide leadership and support to your team, ensuring...

Job SummaryThe Customer Solution Center Appeals and Grievances Specialist II will be responsible for receiving, investigating, and resolving member and provider complaints and appeals in a timely and professional manner. This role requires strong analytical and problem-solving skills, as well as the ability to exercise independent judgment and make sound...

About the RoleWe are seeking a highly skilled Care Manager to join our team at Blue Shield of CA. As a key member of our Population Health Management team, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.Key ResponsibilitiesDevelop and implement individualized care plans to promote quality of care and...

Job Title: Medical Director-Medicaid Appeals and OptimizationWe are seeking a highly skilled Medical Director to lead our Medicaid Appeals and Optimization team. As a key member of our organization, you will be responsible for ensuring that our members receive the most cost-effective and appropriate medical care.Key Responsibilities:Lead Medicaid appeal...

Job Title: Medical Director-Medicaid Appeals and OptimizationWe are seeking a highly skilled Medical Director to lead our Medicaid Appeals and Optimization team. As a key member of our organization, you will be responsible for ensuring that our members receive the most cost-effective and appropriate medical care.Key Responsibilities:Lead Medicaid appeal...

Care Management Nurse Job DescriptionAt New Century Health Plan, we are seeking a highly skilled Care Management Nurse to join our team. As a Care Management Nurse, you will play a vital role in coordinating care for our Medicare Advantage members.Key Responsibilities:Develop and implement individualized care plans based on Health Risk Assessment.Facilitate...

Job OverviewPositions available for a Quality Assurance Nurse and a Compliance Specialist. QUALITY ASSURANCE NURSEOBJECTIVE:The Quality Assurance Nurse plays a crucial role in collaboration with the Medical Director, the VP of Clinical Policy, and the Quality Management Committee to develop, implement, and enhance the Quality Management Program. This...

Care Management Nurse Job DescriptionAt New Century Health Plan, we are seeking a highly skilled Care Management Nurse to join our team. As a Care Management Nurse, you will play a vital role in coordinating care for our Medicare Advantage members, focusing on improving health outcomes and streamlining the care journey for members with complex healthcare...

Job SummaryWe are seeking a highly motivated and experienced Union Representative/Organizer to join our team at Service Employees International Union. The successful candidate will be responsible for leading strategic campaigns to promote the interests of our members and advance the goals of our union.Key ResponsibilitiesDevelop and implement strategic plans...