• Grievance and Appeals

    VNS Health (Manhattan, NY)
    …criteria. + Enters data and assists with compiling reports and analysis on the grievance and appeals process. + Participates in special projects and performs ... and current registration to practice as a registered professional nurse in New York State required Education: + Bachelor's...care, including a minimum of two years in a grievance and appeals or related area such… more
    VNS Health (09/20/24)
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  • Appeals and Grievance

    Baylor Scott & White Health (Temple, TX)
    **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for...case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy Technicians for handling where required.… more
    Baylor Scott & White Health (10/30/24)
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  • Customer Solution Center Appeals

    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 ...is primarily responsible for the overall coordination of the Appeals & Grievance (A&G) program for LA… more
    LA Care Health Plan (11/04/24)
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  • Customer Solution Center Appeals

    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 Angeles, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist...and Pharmacy requests and makes accurate judgment on appeal, grievance , Provider Claim Disputes, medical records or other issues… more
    LA Care Health Plan (10/11/24)
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  • Clinical Appeals Specialist

    CDPHP (Albany, NY)
    …these 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 that meets state, federal, accreditation and other...knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests,… more
    CDPHP (10/26/24)
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  • Utilization Review Specialist (LVN)

    Kelsey-Seybold Clinic (Houston, TX)
    …determined within appropriate timeframes. This position will serve as a liaison to the Grievance and Appeals Department for Medicare Advantage appeals . The ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to determine… more
    Kelsey-Seybold Clinic (11/05/24)
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  • CDOC (Health Professional VI) - Health Service…

    State of Colorado (Canon City, CO)
    …at the informal level; + Ensures staff compliance with the offender grievance process, offender co-pay, electronic data entry, and information systems requirements; ... Administrative Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel Director's Administrative… more
    State of Colorado (10/25/24)
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  • CDOC Part time Physician

    State of Colorado (Denver, CO)
    …are performed on-site; + Accountable for the work product of Nurse Practitioners and Physician Assistants. Accountability involves direct line authority, clinical ... referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative… more
    State of Colorado (10/29/24)
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