- 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
- UCLA Health (Los Angeles, CA)
- Description As the Appeals & Grievances Nurse , you will play a key role in managing and resolving New Century Health Plan member appeals and grievances. You ... BSN or MSN degree, required * Current valid California RN license, required * Minimum of 2 years' experience...Advantage setting is highly desired * Experience in handling appeals , grievances, utilization management, or potential quality issues *… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II...under the direct supervision and management of the A&G Nurse Specialist, RN and/or Medical Director. This… more
- Select Medical (Los Angeles, CA)
- …Medical Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse ( RN ) or Licensed Clinical Social Worker (LCSW) **Pay Rate: ... overseeing negotiations of continued stay rationale, length of stays, and appeals process. Initiates activities to develop positive business relationships with… more
- LA Care Health Plan (Los Angeles, CA)
- …an enthusiastic team player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017… more
- Providence (Mission Hills, CA)
- …+ Bachelor's Degree in Nursing or other related area + Upon hire: California Registered Nurse License + 5 years Healthcare management experience related to acute ... The Manager assists the Regional Director of Utilization Management, Appeals & Clinical Training through the provision of ongoing...care utilization management or appeals management. **Preferred Qualifications:** + Master's Degree in Nursing… more
- UCLA Health (Los Angeles, CA)
- …and coordinate the care for our Medicare Advantage members. As a Care Management Nurse , you will focus on improving health outcomes and streamlining the care journey ... in the Complex Care Management program. + Support the Appeals & Grievances team in resolving members' concerns. +...BSN or MSN degree, required + Current unrestricted California RN license, required + Three or more years of… more
- Prime Healthcare (Ontario, CA)
- …Utilization Review or Case Management with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA) certificate upon hire and maintain ... Service, to provide guidance on complex Authorizations, Referrals, Denials and Appeals . + Integrates and coordinates services using continuous quality improvement… more