- 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)
- …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 - Medical Management - RN - Grievances & Appeals ** **Location:** This position will work a hybrid model (remote and office). The ideal candidate ... Schedule:** M-F with rotation for Saturday. **Manager II - Medical Management - RN - Grievances & Appeals ** is responsible to manage a team of clinicians… more
- Elevance Health (Columbus, OH)
- ** Nurse Appeals - Licensed RN ...and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet ... ET (will work weekends and holidays as needed). The ** Nurse Appeals ** position is responsible for investigating...skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a… more
- Elevance Health (Walnut Creek, CA)
- ** Nurse Appeals (Quality) - California candidates...skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a ... will make an impact:** Responsible for investigating and processing quality of care grievances from members and providers. **Primary duties may include, but are not… 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, July 1, 2024 Centers Plan for Healthy Living's goal is to ... in related area of responsibility, (ie utilization management, quality management, grievances , and appeals ) Type of Experience Required: Strong analytical… more
- Healthfirst (IA)
- …Triage and assign expedited appeals while helping standardize and optimize how Appeals and Grievances are routed + Manage inventory to ensure regulatory ... meet production, compliance and quality targets to perform all Appeals & Grievances tasks + Build partnerships...TruCare and Hyland. **Preferred Qualifications:** + Bachelors degree + RN or LPN strongly preferred + Experience in clinical… more
- The Cigna Group (Nashville, TN)
- …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
- 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
- Access Dubuque (Dubuque, IA)
- …surgical procedures, authorization requests, part C validation, Medicare Universe reporting, denials, appeals , grievances , and bed days performed by UM Nurses. ... Bachelors Degree or Masters Degree in healthcare related fields. RN license required, BSN preferred. **Interpersonal Skills:** Strong interpersonal relationship… more
- Healthfirst (NY)
- …+ Bachelors degree + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization ... management/case management. + Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently on several computer applications such as Microsoft Word… more
- Centers Plan for Healthy Living (Staten Island, NY)
- UM RN 75 Vanderbilt Ave, Staten Island, NY 10304,...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
- LA Care Health Plan (Los Angeles, CA)
- …experience in a patient care setting and/or combination in utilization management, appeals and grievances , delegation oversight, and/or CNA experience. At least ... Utilization Management Nurse Specialist LVN II Job Category: Clinical Department:...quality improvement activities. Communicates to UM Manager and supervising RN , barriers to completing assignments or daily work in… 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
- State of Colorado (Crowley County, CO)
- …statement. 04 Do you possess a valid, active license from the State of Colorado as a Registered Nurse or Nurse Practitioner? + Yes + No 05 Enter your ... and completing performance evaluations per CDOC regulations, and resolves complaints/ grievances at the informal level; + Ensures staff compliance...Colorado Registered Nurse or Nurse Practitioner… 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
- 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 ... interns. Point of contact for the local schools for RN , NP or PA students. Facilitates regular staff meetings....Minimum Qualifications: Current, valid licensure as an Advanced Practice Nurse from any state; or current, valid licensure as… more