• RN - Grievance and Appeals

    Centers Plan for Healthy Living (Margate, FL)
    RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, October 7, 2024 Centers Plan for Healthy Living's ... plans they need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex...in writing. + Analyze and complete written summaries on clinical cases. EDUCATION AND EXPERIENCE: Education: RN more
    Centers Plan for Healthy Living (10/08/24)
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  • Manager, Grievance and Appeals

    VNS Health (Manhattan, NY)
    …Will Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & Grievances Department. + ... and audits subcontractors who have delegated responsibility for managing grievance and appeals on behalf of the...+ License and current registration to practice as a registered professional nurse in New York State… more
    VNS Health (09/04/24)
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  • Appeals & Grievance Specialist

    Commonwealth Care Alliance (Boston, MA)
    …to appeal and grievances. **What You'll Be Doing:** - Processing of Grievances & Appeals . - Responsible for the progress of grievance and appeal intervention and ... strict deadlines. - When necessary collaborate with care teams, clinical staff, family members, and other involved in providing...dental, reporting, and member services. - Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator… more
    Commonwealth Care Alliance (09/07/24)
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  • Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    …The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse ( RN ) II provides direct assistance to member's with ... Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC...agencies. Good working knowledge of regulatory requirements/standards. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
    LA Care Health Plan (10/11/24)
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  • Nurse Appeals ( RN )

    Elevance Health (Los Angeles, CA)
    ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the ... our PulsePoint locations. **Shift:** Monday to Friday from 8:00am-5:00pm PST The ** Nurse Appeals ** is responsible for investigating and processing medical… more
    Elevance Health (11/02/24)
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  • Clinical Appeals Specialist

    CDPHP (Albany, NY)
    …share 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 ... of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity...external review, and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse more
    CDPHP (10/26/24)
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  • Registered Nurse - Care Coordinator…

    CareOregon (Medford, OR)
    RN license in the State of Oregon + Minimum 2 year experience as a Registered Nurse ( RN ) in the healthcare industry + Valid driver's license, acceptable ... and must comply with all federal laws. Job Title Registered Nurse - Care Coordinator (Community) Exemption...For Service program benefits). + Report member complaints to Appeals and Grievance team for investigation and… more
    CareOregon (09/27/24)
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  • Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    Registered Nurses and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary for MD ... Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical...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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  • Vice President, Clinical Operations…

    CareFirst (Baltimore, MD)
    …requirements. + Appeals , Grievances & Clinical Medical Review: Oversees the Appeals and Grievance function as well as Clinical Medical Review for ... Case Management, Utilization Management including prior authorization, and post service clinical medical review and Appeals & Grievances operational functions… more
    CareFirst (09/06/24)
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  • RN -Utilization Management

    ERP International (Nellis AFB, NV)
    **Overview** ERP International is seeking ** Registered Nurse ( RN ) Utilization Managers** for full-time positions in support of theMike O'Callaghan Military ... admissions, including all eligible beneficiaries, to civilian hospitals and notifies Clinical Nurse Case Manager and Patient Administration Element as… more
    ERP International (11/02/24)
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  • Remote Manager Clinical A&G

    Healthfirst (NY)
    …work experience + RN or LPN + Experience with utilization management or appeals and grievance processing and compliance + Working experience in a fast-paced ... and foster effective relationships **Preferred Qualifications:** + Experience in clinical practice with a focus in appeals ...in clinical practice with a focus in appeals & grievances, claims processing, utilization review or utilization… more
    Healthfirst (09/25/24)
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  • CDOC (Health Professional VI) - Health Service…

    State of Colorado (Canon City, 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 ... + Questions Department Information $25,000 HIRING INCENTIVE FOR FULL-TIME CLINICAL PROFESSIONALS! If your goal is to build a...Colorado Registered Nurse or Nurse Practitioner… more
    State of Colorado (10/25/24)
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  • Associate Dean for Faculty Affairs

    University of Connecticut (UConn) (Storrs, CT)
    …and faculty services. + Participates in processes related to faculty counseling, faculty grievance , and appeals related to the SON operations. + Promotes ... and research scholarship with colleagues in the academic and clinical setting. + Ensures that appropriate strategies and policies...(Ph.D., EdD, or equivalent) in Nursing. + Current Connecticut RN license (valid at date of hire). + 3-5… more
    University of Connecticut (UConn) (10/01/24)
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