- 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 ... 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
- 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 program for LA Care… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This ... and Complex Care Needs. Essential Qualifications + Current licensed Registered Nurse ( RN ) with state...within managed care setting. + 3+ years' experience in clinical nurse setting preferred. + Grievance… more
- Elevance Health (Columbus, OH)
- ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in ... am - 5:00 pm ET (will work weekends and holidays as needed). The ** Nurse Appeals ** position is responsible for investigating and processing medical necessity … more
- Elevance Health (Walnut Creek, CA)
- ** Nurse Appeals (Quality) - California candidates only** **Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance ... are resolved timely to meet regulatory timeframes. + Documents and logs appeal/ grievance information on relevant tracking systems and mainframe systems. + Generates… 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 ... (Tuesday ALT Day).** + Must have experience in Medicare Appeals , Utilization Case Management or Compliance in Medicare Part...as well as research and provide a written detailed clinical summary for the Plan Medical Director. + Determine… more
- 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 ... This position provides operational and supervisory oversight of multi-disciplinary clinical services staff working at the Colorado State Penitentiary....Colorado Registered Nurse or Nurse Practitioner… more
- HCA Healthcare (Asheville, NC)
- …for over sight of the Contract Liaison, HIMS Clerk and Service Delivery, Appeals and Grievance (SDAG) Coordinator. Essential Accountabilities: + Develops and ... (5) years of relevant experience in health related field. **Preferred Education:** Clinical training and licensure **Preferred License:** RN , PT, SW **Required… more