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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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The Grievance and Appeals Coordinator will also present cases to the Appeals Committee. The Appeals and Grievance Coordinator will coordinate, process, and document all aspects of member appeals and grievances, as well as provider appeals across all our product offerings (Commercial, Medicaid and Medicare.
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Meets performance measurement goals for Grievance and Appeals Resolution Services. Evaluates case details, proposes recommendations, or makes decisions as applicable; ensures organization decision is implemented according to the Grievance and Appeals policies and case resolution.
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The UMQM Nurse shall also participate in Utilization Management related activities with the Appeals and Grievance Department as well as the Compliance Department to assure that the quality compliance is being met for NCQA, state and federal regulatory requirements.
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In addition to providing legal counseling to the University, other areas of responsibility for the Office of Legal Affairs include policy interpretation and advice, administration of the University's grievance and dispute resolution procedures, contract review, and - in conjunction with the Attorney General - management of actual or threatened litigation in which the University is involved.
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Under the general supervision of the Deputy Bureau Chief of Human Resources/Director of Labor Relations and the Senior Labor & Employment Legal Counsel, acts as a liaison on behalf of County management in serving as hearing officer or mediator for union grievance hearings, resolution meetings, and other Labor/Management activities.
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Participate in leadership team by actively contributing in decision making, grievance follow up, building and company-wide initiatives and attending leadership team meetings such as stand up, Managing Acute Care Conditions (MACC), Nutrition at Risk (NAR), Utilization Review (UR), Quality Assurance Performance Improvement (QAPI) and other meetings as required.
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Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. May also engage in grievance and appeals reviews.
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Wage and hour law disputes; restrictive covenants; workers’ compensation issues; unemployment and other state agency claims; labor relations; employee benefits; employee relations; employment agreements and policy related issues; employee accommodation matters; employment-related litigation; government audits and investigations; labor and employment law compliance; grievance administration; arbitrations; and mediations.
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Assist in managing grievance procedure issues, requests for information and arbitration preparation. Atlantic City Electric (ACE), Baltimore Gas and Electric (BGE), Commonwealth Edison (ComEd), Delmarva Power & Light (DPL), PECO Energy Company (PECO), and Potomac Electric Power Company (Pepco.
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Acts as a liaison on behalf of County management in serving as hearing officer or mediator for union grievance hearings, resolution meetings, and other Labor/Management activities. Acts as the hearing officer in connection with union grievances, schedules grievance hearings, coordinates hearings with necessary parties, interprets collective bargaining agreements and work force policies, and issues decisions.
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Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol. Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol.
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F) Evaluate, mentor and guide residents and other learners, in compliance with established requirements and best practice; manage resident related HR issues, including disciplinary action, due process and grievance, in collaboration with HR and GME Division leadership.
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Inquiries concerning the complaint/grievance procedure related to sex discrimination, including sexual harassment and sexual assault, should be addressed to the Title IX Coordinator, Carrington Hall 205, 901 S. National Ave., Springfield, Missouri 65897, TitleIX@missouristate.edu , 417-836-8506, or to the Office for Civil Rights.
$40,000 - $48,000 a yearFull-timeExpandUpdated 28 days ago - UpvoteDownvoteShare Job
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First line inmate grievance mediator. Supervises inmates and maintains security of Jail and Juvenile Detention Center. First line inmate grievance mediator. Portage County is looking to hire a Corrections Officer to join their team.
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grievance job
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