- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding ... adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge...Case Manager Upon Hire Preferred + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred **Experience:**… more
- CareFirst (Baltimore, MD)
- …+ CCM - Certified Case Manager Upon Hire Preferred. + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred. **Experience:** + 5 years medical-surgical or ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate...School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon… more
- CareFirst (Baltimore, MD)
- …leadership experience. + Master's in Science Nursing or related field, Legal Nurse Consultant , Utilization Management, and Government Program experience with ... and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an experienced people leader… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- CVS Health (Tallahassee, FL)
- …and affordable. **Position Summary** This is a full-time remote Quality Management Nurse Consultant opportunity. Working schedule is Monday-Friday, 8am-5pm in ... as needed. This position reports to the Potential Quality of Care (PQOC) nurse investigator team manager. This position is responsible for the review and evaluation… more
- Sacramento County (Sacramento, CA)
- Licensed Vocational Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448956) Apply Licensed Vocational Nurse D/CF Salary ... 4/4/2025, 7/3/2025, 10/3/2025 In a detention/correctional facility, the Licensed Vocational Nurse D/CF performs a wide variety of vocational nursing duties,… more
- Sacramento County (Sacramento, CA)
- Registered Nurse D/CF (Level I/II) Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/454059) Apply Registered Nurse D/CF (Level I/II) ... at 5:00 pm on: 11/5/2024, 1/2/2025, 3/6/2025, 5/8/2025, 7/3/2025, 9/4/2025, 11/6/2025 Registered Nurse D/CF Level I: $61.27 - $74.48 hourly Registered Nurse D/CF… more
- Alameda Health System (Oakland, CA)
- …and internal compliance studies. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals . ... and/or techniques. + Review cases regularly with staff; acts as clinical consultant regarding care management issues; guides clinical staff with review of… more
- Alameda Health System (Oakland, CA)
- …Medicare and internal compliance studies. -Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals ... equipment and/or techniques. -Reviews cases regularly with staff; acts as clinical consultant regarding care management issues; guides clinical staff with review of… more
- Clark County, NV (Las Vegas, NV)
- …and oversees the work of contract professionals; negotiates and administers consultant contracts. Coordinates and assists in the processing of applications submitted ... retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and...applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +… more
- Sacramento County (Sacramento, CA)
- …of California to practice as a: Either: 1. Psychiatric Technician Or: 2. Registered Nurse Or: 3. Vocational Nurse Note: The word "experience" referenced in the ... language other than standard English; and/or act as a consultant to others regarding the needs and problems presented...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more
- City and County of San Francisco (San Francisco, CA)
- …of experience as a Licensed Psychiatric Technician or a Licensed Vocational Nurse providing psychiatric nursing care in a skilled facility or psychiatric acute ... permanent or temporary (including an interim permit) California Licensed Vocational Nurse License or Licensed Psychiatric Technician License. Applicants must meet… more
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