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The Grievance and Appeals Quality Assurance Program Manager is responsible for performing retrospective and concurrent internal quality review of grievances and appeals to ensure they are categorized and processed in accordance with state and federal regulatory requirements and SCFHP policies and procedures as set forth for each line of business.
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Develops and maintains current knowledge of state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care, managed long term care as well as contractual requirements.
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Present grievance and appeals data to key stakeholders through Grievance Review Committee (GRC) and the Grievance Program Leadership Team (GPLT). Under the direction of the Interim Supervisor of Grievances and Appeals, you will help to investigate and resolve member and provider grievance and appeals, while following all regulations and standards for processing grievances and appeals.
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Oversees annual giving functions, including giving days, unit-based appeals, parent appeals, faculty/staff/retiree appeals, crowdsourcing, student callers, and related activities.
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The Civil Litigation Division represents the State’s interests in Arkansas State Circuit Courts, Arkansas State Claims Commission, and Federal District Courts, as well as appeals to the Arkansas Supreme Court and Court of Appeals, and the Eighth Circuit Court of Appeals.
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Duties:Conduct legal research and analysis on various litigation matters, including commercial disputes, appeals, antitrust cases, constitutional issues, energy-related disputes, oil and gas matters, and class actions.
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Counsel on alcohol laws, regulations, and guidance documents with respect to complex regulatory issues relating to product development, product lifecycle management, manufacturing operations, quality, and M&A transactions.
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Two (2) years of progressively responsible experience in regulatory affairs, legislative affairs, or energy policy at an electric utility, regulatory agency, or legislative office. The Policy Advisor works under the direction of the Manager of Energy Policy, representing Central Coast Community Energy in various regulatory and compliance matters.
$179,257 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The position is eligible for overtime compensation for all hours worked over 40 in the designated workweekJob TypeUnclassifiedDepartmentCounty AttorneyAbout the PositionAs a Paralegal within the Appeals, Election Law, Public Records, & Tax Practice Group of the Civil Services Division, your primary focus involves processing public records requests for the Maricopa County Attorney and county clients, including the review and redaction of audio/visual records.
$22 - $37.75 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Regulatory expertise in project leadership, preferably negotiation with and conduct of meetings with the FDA and successful preparation and submission of IND/CTA/MAA/NDA/BLA with explicit CMC focus for biologics and/or small molecule modalities.
$241,925 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Collaborates with mid-cycle Coding Audit Team leaders for topics related to CRC coding auditor operations and appeals. Registered Nurse (RN), Licensed Vocational Nurse (LVN), or Licensed Practical Nurse (LPN.
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Member, Eligibility (LOB, Plan), Provider, Claim data, about Risk Calculation, Care Plan Implementation, Grievance and Appeals, Patient Management Utilization Management (Authorization), Drug-Drug Interaction, Medications and Lab data Management, CDPS (Analytics) etc., Azure, EDI.
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The Global Regulatory Strategy Head’s organization is accountable for all CMC regulatory activities in order to guarantee that all global products manufactured at or on behalf of Roche or supplied to Roche (DS, DP and packaging operations) fulfill and maintain our right to operate by meeting Regulatory expectations.
$408,450 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Firm Type: Law Firm, Experience: 4 Years, A law firm in Omaha, NE, is seeking an Energy Regulatory/Corporate Associate Attorney with 4-5 years of experience in energy transactional and regulatory litigation and compliance.
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The Executive Director, Regulatory Affairs will develop and execute global regulatory strategic and tactical guidance for the development of innovative new drugs in rare disease ensuring fast to market global product registrations, product promotion, maintenance of products and processes in regulatory compliance with local regulations.
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appeals regulatory jobs Company: Jackson Health System
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