- CareFirst (Baltimore, MD)
- …process for our membership, and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an ... in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse -... Consultant, Utilization Management, and Government Program experience with Appeals and Grievance , Experience with MCG, InterQual,… more
- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals ( RN )to lead the daily operations of our ... direct oversight and the day to day management of clinical appeals review processes within Appeals...+ License and current registration to practice as a registered professional nurse in New York State… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor ( RN ) directs and coordinates the accurate implementation of the clinical appeal ... and serves as a resource for associates within the Clinical Appeals and Analysis unit supporting Government...**Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse -… more
- Elevance Health (Costa Mesa, 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
- Healthfirst (NY)
- …Responsibilities:** + Conduct quality audits of A&G items including grievances, pre-service appeals , and post service appeals utilizing appropriate sources of ... improve processes and performance to ensure quality. + Review and investigate appeals and grievances requests to ensure all requests are identified, classified, and… more
- CVS Health (Frankfort, KY)
- … coverage, and policies. Responsible for the review and resolution of clinical complaints/grievances and appeals . Interprets data obtained from clinical ... as required. Requires LPN/LVN with unrestricted active license. Assists with reviewing clinical complaint/ grievance and appeal requests of all clinical … more
- 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