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The Program Manager is a key member of the Medicare Advantage Claims, Configuration and Appeals and Grievance Operations team. Assists in planning, developing, implementing, and managing the Medicare Advantage Claims, Appeals and Grievance program requirements, operational initiatives and policies.
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Serves as the lead person for the investigation, reporting and resolution of patient grievances. Works closely with the manager of patient relations to ensure that patient representatives maintain compliance with CMS standards in documentation and grievance follow up.
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For information on the Title IX Sexual Harassment/Sexual Assault policy and grievance procedures, please click here. The report contains information regarding campus security and personal safety including topics such as: crime prevention, public safety authority, crime reporting policies, fire safety, disciplinary procedures and other matters of importance related to security on campus.
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Under general supervision of the Grievance and Appeals Manager performs a variety of complex, responsible and confidential duties requiring a thorough knowledge of organizational procedures and precedents perform routine clerical, administrative duties in support of the Grievance and Appeal Department.
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Successful Candidate will administer and provide functional support for multiple areas of Human Resources across our Ithaca based campus, including but not limited to Collective Bargaining, Contract administration, Strategic Labor Relations, HR compliance, employee relation, performance management, and Grievance Administration.
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The incumbent reviews and analyzes key program, regulatory and operational performance indicators for the functional areas reporting to the Assistant Director, Medicare Advantage Operations and makes recommendations to the leadership team on strategies to improve performance.
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Strong project management skills with the proven ability to deliver agreed objectives with timeframes, including experience in project outcome reporting utilizing industry standards. Along with the Assistant Director, Medicare Advantage Operations, the Program Manager is responsible for program management activities impacting the functional areas within the span of control of the Assistant Director including but not limited to initiation, planning, development, and monitoring of program implementations and day to day operations performance monitoring in order to ensure timeliness and compliance.
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The Employee Relations Specialist consistently demonstrates knowledge of established policies and procedures and maintains the issue resolution and grievance process. Essential functions of this position are listed on the Assessment and Evaluation Tool. REPORTING RELATIONSHIPThis position reports to the Director of Human Resources.
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If the person bringing the complaint or the alleged offender is dissatisfied with the outcome of the investigation, either individual has the right to seek reconsideration of the decision through the Company's grievance procedures.
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Capable of handling employee conflict, following grievance procedures, mediating and conflict resolution. ProfitResponsible for claims and safety related training, prevention initiatives, and claims processing including claims investigation, client and guest follow-up, and compliant reporting.
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Experience in Medicare Advantage Claims, Appeals & Grievances, program/project management. Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Medicare Program Manager.
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The Grievance & Appeals Compliance Specialist, in coordination with Corporate Regulatory staff, ensures the Grievance & Appeals (G & A) team is in compliance with contract requirements and ensures that review, submission and required reporting deadlines are met.
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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. 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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Complete grievance and investigation forms, reporting findings for each case presented from internally managed online platforms and external health provider companies. Perform ongoing tracking of all grievances and reporting thereafter.
$30 - $40 an hourFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Must have experience in the complaint/grievance management, along with vast knowledge of CMS, DOH, DNV regulations around patient rights and compliance to policies and procedures regarding complaint and grievance management.
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