- VNS Health (Manhattan, NY)
- VNS Health is seeking a Registered Nurse ( RN ) Clinic Utilization Review for a nursing job in Manhattan, New York.Job Description & RequirementsSpecialty: ... Utilization ReviewDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffResolves grievances , appeals and external reviews for one of the following… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse ( RN ) II provides direct assistance to member's… more
- CDPHP (Albany, NY)
- …, NYS external review, and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse Practitioner, with ... values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance process… more
- Centene Corporation (Raleigh, NC)
- …or equivalent experience. Master's Degree preferred. 5+ years of experience in grievances , appeals , or healthcare law related fields. Previous management ... our Raleigh office. **Position Purpose:** Responsible for oversight of member appeals and grievance processes. Directs and ensures the efficient operational… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, August 5, 2024 Centers Plan for Healthy Living's goal is ... in related area of responsibility, (ie utilization management, quality management, grievances , and appeals ) Type of Experience Required: Strong analytical… more
- The Cigna Group (Bloomfield, CT)
- …duties as assigned. **Qualifications** + Education: Licensed Practical Nurse (LPN) or Registered Nurse ( RN ) + 3-5 years' experience in Medicare Advantage ... in Medicare Part C + Ability to differentiate different types of requests Appeals , Grievances , coverage determination and Organization Determinations in order to… more
- Stanford Health Care (Palo Alto, CA)
- …+ Master's degree in nursing (MSN) + Current unrestricted license as a Registered Nurse issued by the state of California. + National certification ... review, retrospective review of care, medical claims review, addressing denials/ appeals and grievances effectively and timely, and...timely manner. **Licenses and Certifications** + ACM + CA Registered Nurse - Valid license as a… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …and/or elective surgical cases preferred. Essential Qualifications * Current licensed LPN or Registered Nurse ( RN ) with state licensure. Must retain active ... review of services and care. * Provides referrals to Case management, Disease Management, Appeals & Grievances , and Quality Departments as needed. * Develop and… more
- Commonwealth Care Alliance (Boston, MA)
- …lines or medical setting preferred + Prior experience with service authorizations, grievances and appeals , scheduling medical appointments preferred + Ability to ... record, (if applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer.… more
- Centene Corporation (Olympia, WA)
- …of EPSDT program as well as compliance and turnaround time of grievances and appeals . **Education/Experience:** Bachelor's degree in Nursing or related ... running Risk Adjustment prospective and retrospective programs preferred **License/Certification:** RN license and Certified Professional in Health Care Quality… more
- Sacramento County (Sacramento, CA)
- …Employment Qualifications Minimum Qualifications Possession of a current valid license as a registered nurse and a Nurse Practitioner certification issued by ... Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days...must submit a copy of both my current valid Registered Nurse license AND my Nurse… more
