- 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
- 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
- Prime Healthcare (Ontario, CA)
- … Appeals . + Integrates and coordinates services using continuous quality improvement initiatives to promote positive member outcomes. #LI-RK1 Qualifications ... other applicable documents. + Integrates and coordinates services using continuous quality improvement initiatives to promote positive member outcomes. + Frequent… more