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Department(s): Grievance & Appeals Resolution Services (GARS)Reports to: Manager, Grievance & AppealsSalary: $24.52 - $31.04 Duration: up to 6 months Job Summary 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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Serve as subject matter expert for Department of Managed Health Care (DMHC) and contracted health plans quarterly and annual audits related to Grievance and Appeals, Access and Availability, Language Assistance, Website, and Provider Network Changes.
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The Grievance and Appeals Nurse Specialist participates in managing medical appeals and state hearing reviews for all lines of business, including handling expedited and standard requests.
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Makes medical necessity determinations for grievance and appeals appropriate for their specialty. The Sleep Clinical Operations Associate Medical Directo r is a Sleep Specialist participating in pre-authorization and quality improvement solutions for sleep studies and high-tech general medicine diagnostic imaging.
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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 highly experienced attorneys advise and counsel in complex business and litigation matters, handling litigation in state and federal courts, and briefing and arguing appeals in courts, including the California Supreme Court and the Ninth Circuit Federal Court of Appeals.
Full-timeExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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In addition to direct representation, IRP engages in advocacy at the local and national levels, recruits, trains, and mentors hundreds of pro bono attorneys each year, handles appeals before the Board of Immigration Appeals, Ninth Circuit Court of Appeals, and California Court of Appeal, and conducts impact litigation.
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Under general supervision, the Program Assistant will assist with specialized services relevant to the Grievance and Appeals Resolution Services (GARS) department. The incumbent’s primary responsibilities will include monitoring the GARS member and provider mailbox, fax, mail and processing appeals and grievances for assignment to key staff within the required timeframe.
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Under general supervision, the Program Assistant will assist with specialized services relevant to the Grievance and Appeals Resolution Services (GARS) department and will be responsible for monitoring the GARS member and provider mailbox, fax, mail and processing appeals and grievances for assignment to key staff within the required timeframe.
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Duty Locations Locations are offered based on operational requirements, mission requirements, and critical agency hiring needs as determined by AMO. The duty location listed in a final offer letter may include any geographic location within the Southeast Border Region, Caribbean Air and Marine Branch (CAMB), Southwest Border Region, and National Air Security Operation Centers (NASOC) Unmanned Aircraft System (UAS) locations.
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As an Indirect Tax Manager, you will efficiently manage Indirect Tax compliance, tax research, audits and appeals utilizing enhanced technology and process improvements and will perform other Indirect Tax function duties as assigned by the Indirect Tax Leader.
$92,318 - $155,318 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Preparing Process and Instrumentation Diagrams (P&IDs), control system network diagrams, control panel wiring diagrams, equipment layouts, I&C system specifications, and installation details.
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Own major feature development and rollout of large features for our products - recent examples include building a Software-in-the-Loop simulator for our Anvil product and characterizing and improving Ghost helicopter battery consumption with route planning.
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Collaborates and partners with other departments including Franchise Sales, Company and Franchise Operations, Marketing, and Construction to support brand growth in new markets. Minimum of 5+ years of experience in restaurant/hospitality design, preferably in multi-state, fast casual dining and quick service restaurant operations in a corporate or franchise environment.
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Responsible for Writs, Appeals, civil litigation, trials, damage or other civil suits in State and federal courts, including advanced appellate work and the representation of the City's Police Department and its officers in Pitchess Motions, as directed by the City Attorney or the Chief Assistant City Attorney.
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grievance and appeals jobs in Costa Mesa, CA
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