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Serve as Hearing Officer for grievances and disciplinary appeals at the Step II level. Reporting directly to the Deputy Commissioner of Human Resources and Facilities Management (HRFM), the Director of Labor Relations will administer the Agency's labor relations program.
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Professional experience with all steps of the grievance process, policy development, dispute resolution, as well as necessary familiarity with agency management and operations. Negotiate settlements in connection with grievance disputes and collective bargaining activities.
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Reporting to the Director Labor Relations, the Sr Labor Relations Specialist will act as a subject matter expert (SME) of the assigned labor relations area, in advocacy or administration; provide leadership and guidance to junior level staff; and may be assigned core duties involving the most complex grievance procedures, mediation sessions, monitoring and implementing collective bargaining agreements (CBAs), dispute resolution, policy development, and claim investigations.
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Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc.
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Works with Plan Leadership, Provider Performance Value Based Care (PPVBC Team), Quality, VBS reporting team and other staff to manage contract performance and drives the development and implementation of value based contract relationships in support of business strategies.
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Works with Quality Team, Health Plan Leadership team, VBS reporting team and other staff to manage contract performance and drives the development and implementation of value based contract relationships in support of business strategies.
$67,900 - $149,300 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Job SummaryThe Supervisor, Customer Solution Center Appeals & Grievances is responsible for direct supervision and support of the team responsible for the intake, research, resolution, tracking, trending and reporting within the Appeals & Grievances department.
$77,265 - $123,625 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Maintains knowledge of grievance/appeal reporting requirements for the Office of the Center of Medicare/Medicaid Services, DHS, and Metastar. This position interfaces with the Department of Health Services (DHS), the Division of Hearings and Appeals (DHA), Ombudsman Program, the.
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The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions.
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Departments reporting to this position include: Appeals and Grievance, Claims, Enrollment and Reconciliation, Premium Billing, Member Service and Experience, and Member Innovation.
$300,000 - $350,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Maintain an understanding of utilization management/grievance and appeals program objectives and design, implementation, management, monitoring, and reporting.
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Liaison to Services team coordinating efficient and accurate member ad provider servicing as well as Grievance and Appeals processing according to CMS requirements and regulations.
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Seek to resolve differences in accordance with the scriptural patterns summarized in the Staff Manual policy on Fair Treatment as well as the Grievance and Appeals Procedure. Complete routine tasks related to AV such as soldering cables and connections, editing audio and video, and archiving recordings.
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The BPS Manager will generate and provide metrics and reporting to demonstrate the performance of the BPS work. Coordinates reporting and communications within the organization's compliance team or external compliance counterparts.
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We are looking for a Program Manager II (Director of Targeted Oversight), who reports directly to the Assistant Bureau Chief of Managed Care. Oversees a team focused on targeted Managed Care Organization (MCO) oversight that includes the following areas of compliance monitoring: Encounter submissions, Network adequacy, member grievance and appeals, managed care organization subcontracting arrangements, and health plan marketing.
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grievance appeals and reporting jobs
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