- VNS Health (Manhattan, NY)
- …requirements. Also monitors and audits subcontractors who have delegated responsibility for managing grievance and appeals on behalf of the plan to ensure ... collection systems and prepares data reports and analysis of grievance and appeals for program management and...+ License and current registration to practice as a registered professional nurse in New York State… more
- Henry Ford Health System (Troy, MI)
- …prompt and thorough investigation of medical, transportation, and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare ... + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center...At least two (2) years of member appeal and grievance experience . + Minimum of two (2) years… more
- LA Care Health Plan (Los Angeles, CA)
- …purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to ... Customer Solution Center Appeals and Grievances Nurse Specialist RN...agencies. Good working knowledge of regulatory requirements/standards. Licenses/Certifications Required Registered Nurse (RN) - Active, current and… more
- CDPHP (Albany, NY)
- …, grievances, NYS external review, and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse Practitioner, with ... to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider...is responsible for adhering to a member/provider appeal and grievance process that meets state, federal, accreditation and other… more
- The Cigna Group (Bloomfield, CT)
- …activities as needed. + Additional duties as assigned. **Qualifications** + Education: Licensed Practical Nurse (LPN) or Registered Nurse (RN) + 3-5 years' ... with every other weekend (Tuesday ALT Day).** + Must have experience in Medicare Appeals , Utilization Case Management or Compliance in Medicare Part C + Ability to… more
- VNS Health (Manhattan, NY)
- …related compliance or quality improvement initiatives. + Provides clinical support in the Grievance and Appeals process. + Participates in the development and ... Certifications: + Current license and registration to practice as a Registered Professional Nurse . required + Valid driver's license or NYS Non-Driver photo ID… more