- Elevance Health (Costa Mesa, CA)
- ** Nurse Appeals ( Quality ) - California candidates only** **Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance ... + Utilizes leadership skills and serves as a subject matter expert for appeals /grievances/ quality of care issues and is a resource for clinical and non clinical… more
- Elevance Health (Costa Mesa, CA)
- ** Nurse Appeals - Licensed RN Nurse...skills and serves as a subject matter expert for appeals /grievances/ quality of care issues and is a resource ... locations. **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and processing medical necessity appeals… more
- Elevance Health (Cerritos, CA)
- The ** Nurse Medical Management** **I** is responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize ... promote effective use of resources. Ensures medically appropriate, high quality , cost effective care through assessing the medical necessity...of care and accurate claims payment. May also manage appeals for services denied. **How you will make an… more
- Elevance Health (Costa Mesa, CA)
- The Nurse Medical Mgmt II responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and ... of resources for more complex medical issues. Ensures medically appropriate, high quality , cost effective care through assessing the medical necessity of inpatient… more
- Molina Healthcare (Long Beach, CA)
- …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the...+ Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the… more