- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist...under the direct supervision and management of the A&G Nurse Specialist, RN and/or Medical Director. This… 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
- LA Care Health Plan (Los Angeles, CA)
- …an enthusiastic team player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US,… more
- Elevance Health (Walnut Creek, CA)
- **Manager II Grievance/ Appeals ( RN )-California** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within ... + **Costa Mesa** + **Palo Alto** + **Walnut Creek** The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals… more
- VNS Health (Manhattan, NY)
- …complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals ( RN )to lead the daily operations of our grievance and ... Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long...+ License and current registration to practice as a registered professional nurse in New York State… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Elevance Health (Los Angeles, CA)
- ** Nurse Appeals - Licensed RN ...and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet ... locations. **Shift:** Monday to Friday from 8:00am-5:00pm PST The ** Nurse Appeals ** is responsible for investigating and...skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a… 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
- CareFirst (Baltimore, MD)
- …people. **QUAIFICATIONS:** **Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor ( RN ) directs and coordinates...data related to the volume and complexity of the appeals and grievances submitted for resolution. **SUPERVISORY… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances , appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully ... or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers....Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in… more
- CareFirst (Baltimore, MD)
- …Management including prior authorization, and post service clinical medical review and Appeals & Grievances operational functions for all lines of business. ... authorization meet all Federal, State and NCQA requirements. + Appeals , Grievances & Clinical Medical Review: Oversees...operating budgets, and large teams. **Preferred Qualifications:** + MBA, RN or MD/DO. + Previous experience at the Vice… more
- CareFirst (Baltimore, MD)
- …Clinical Appeals and Grievances documentation written by the clinical appeals nurse and non-clinical supporting team members within the Appeals ... is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or… more
- Centers Plan for Healthy Living (Jamaica, NY)
- UM RN 90-27 Sutphin Blvd, Jamaica, NY 11435, USA...the issues appropriately + Have a knowledge of the Appeals and Grievances process + Assists members ... and plans they need for healthy living. JOB SUMMARY: The Utilization Management nurse works within a multidisciplinary team to help identify and manage members who… 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
- Covenant Health Inc. (Knoxville, TN)
- …quality improvement or risk management field. Licensure Requirement: Current licensure as a Registered Nurse in the State of Tennessee. Apply/Share Job Title ... training + Where appropriate, will assist in resolving customer complaints and grievances by providing appropriate data and input. + Involved in Preceptor Program,… more
- State of Colorado (Colorado Springs, CO)
- …conflicts, investigates and problem solves internal and external complaints and grievances from staff, youth, family, and other customers. Scheduling of clinic ... to include students and interns. Point of contact for the local schools for RN , NP or PA students. Facilitates regular staff meetings. Data and Reporting: Collects… more