- Harbor Health Services, Inc. (Mattapan, MA)
- …in quality and consistency of decisions. Supervisory responsibilities for UM RN , Quality Analyst, Appeals and Grievances Specialist. Requirements: Bachelor's ... knowledge of all aspects of managed care medical management including UM/CM, Grievance and Appeals , inpatient and outpatient services, medical policy, and… more
- LA Care Health Plan (Los Angeles, CA)
- …the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Licensed Registered Nurse ( RN ) - Active, current and ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC ...assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical … more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & ... & grievance process. Create a best in clinical appeals process that is efficient and...Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Elevance Health (Mason, OH)
- ** Nurse Appeals -Licensed Nurse ** **Location** : Ohio, candidates must be residents of Ohio to be considered. **Hybrid 1** : This role requires associates to ... necessary and is dependent on court hearing schedules. The Nurse Appeals is responsible for investigating and...directors and consultants; preparing recommendations to uphold or deny appeals ; and ensuring all grievance processes are… more
- Elevance Health (Columbus, OH)
- ** Nurse Appeals RN ** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Fields _(Must be within commutable distance to the listed locations.)_ ... for employment, unless an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and processing and medical… more
- BayCare Health System (Clearwater, FL)
- …Qualifications:** + 2 years of experience with case management and/or clinical appeals or claims. + Registered Nurse **Facility:** BayCare Health System, ... team member be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Clinical Appeals Nurse - Health Plan **Location**… more
- Elevance Health (FL)
- ** Nurse Appeals - Litigation & Legal Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, ... necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support**...directors and consultants; preparing recommendations to uphold or deny appeals ; and ensuring all grievance processes are… more
- CVS Health (Baton Rouge, LA)
- …of responses from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Identify trends and emerging issues and ... recommend solutions. In particular responsible for the review and resolution of clinical documentation, clinical complaints and appeals . Reviews… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …and Management Team + Legal Department: + Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare Advantage, and InterPlan Program) + ... the Peer Review Specialist works closely with CPR's Director and Clinical Lead, Operations Lead, Senior Credentialing Manager/ Compliance Consultant, Risk… more
- State of Colorado (Canon City, CO)
- …with accessibility in mind. Preferred Qualifications: + A current, valid license as a Registered Nurse from the Colorado Board of Nursing, or any state ... 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… more
