- Baylor Scott & White Health (Temple, TX)
- …on position type and/or level **JOB SUMMARY** **HYBRID POSITION** The Appeals & Grievances ( Medical Auditor ) RN conducts reviews of medical records, ... and plan documentation to conduct thorough written reviews of appeals , grievances , and reconsiderations using evidence-based medical guidelines to assist the… more
- Healthfirst (NY)
- **Duties and Responsibilities:** + Conduct quality audits of A&G items including grievances , pre-service appeals , and post service appeals utilizing ... and improve processes and performance to ensure quality. + Review and investigate appeals and grievances requests to ensure all requests are identified,… more
- Molina Healthcare (Mesa, AZ)
- …team responsible monthly auditing of HCS staff. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with ... previous Appeals and Grievances experience and a clinical...+ Audits for clinical gaps in care from a medical and/or behavioral perspective to ensure member needs are… more
- Dignity Health (Bakersfield, CA)
- …manner to the health plan. - Partners as needed with the appeals and grievances functions of the department. **Qualifications** **Minimum Qualifications:** ... dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to… more