Lead Customer Solution Center Appeals and Grievances RN - Los Angeles, CA

The Grievance & Appeals Coordinator supports the resolution of member and provider grievances and appeals by analyzing claims, authorizations, and formal complaints. · ...

+The Grievance & Appeals Coordinator supports the resolution of member and provider grievances and appeals by analyzing claims, authorizations, and formal complaints. This role ensures timely, accurate case handling while maintaining high quality and compliance standards. · +- Re ...

You could be the one who changes everything for our members as a clinical professional on our Medical Management/Health Services team. · ...

The Senior Director and Grievance Officer (A&G), is responsible for leadership of L.A. · Care's grievance, appeal functions across all product lines.This position ensures all cases are processed accurately · and consistently with exceptional quality, · and within required timefr ...

+The Senior Director and Grievance Officer · ++• Proactively translates regulatory clinical service strategy into disciplined operational execution by setting clear expectations establishing consistent processes ensuring teams have the tools training data needed to perform at a ...

The Appeals and Grievances Lead is responsible for assisting with the development of a successful and cohesive Appeals and Grievance unit. · Providing direction to the team. · Handling internal or external questions or issues raised in relation to Appeals or Grievances. · ...

The Senior Director and Grievance Officer is responsible for leadership operational execution clinical regulatory oversight enterprise governance of L.A. Care's grievance appeal State Fair Hearing functions across all product lines. · ...

The Grievance & Appeals Regulatory Manager is responsible for working directly with providers in investigating and resolving cases. · ...

The Senior Director and Grievance Officer is responsible for leadership of L.A. Care's grievance appeal operations across all product lines. · ...

Imperial is seeking an Appeals and Grievances coordinator to help with the exchange side of Medical. · ...

The Appeals & Grievance Coordinator is responsible for the day-to-day functions of tracking and trending all grievances, appeals, and complaints received within the Member Services Department. · Will appropriately acknowledge the receipt of all grievance/appeals, · Responsible fo ...

Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. · Position Purpose: · Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of fo ...

The Customer Solutions Center Appeals and Grievance (A&G) Training Specialist II is responsible for providing ongoing training on the core processing system, · A&G processing procedures, · training regulatory changes which will affect established procedures, · working with the qu ...

The Supervisor, Customer Solution Center Appeals and Grievances is responsible for direct supervision and support of the team responsible for the intake, research, resolution, tracking, trending and reporting within the Appeals and Grievances department. · ...

Job summaryThe Supervisor Customer Solution Center Appeals and Grievances is responsible for direct supervision and support of the team responsible for the intake research resolution tracking trending and reporting within the Appeals and Grievances department. · Bachelor's Degree ...

The Appeals & Grievances Resolution Specialist supports the intake, · investigation, and resolution of member grievances, · appeals, provider disputes, and complaints in accordance with CMS · regulations. · Ensure cases are processed within required turnaround times accurately tr ...

The Appeals & Grievance Coordinator is responsible for the day to day functions of the tracking and trending of all grievances appeals and complaints received within the Member Services Department. · Will appropriately acknowledge the receipt of all grievance/appeals CTM (Complai ...

The Grievance and Appeals Nurse Specialist manages medical appeals and state hearing reviews across all lines of business, · handling both expedited and standard requests.This role ensures compliance with regulations,policies,and procedures while preparing case narratives and pos ...

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. · Clever Care was created to meet the unique needs of the diverse comm ...

The Team You'll Join: We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. · ...

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. · ...