- 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 ... or Medicare Advantage setting is highly desired * Experience in handling appeals , grievances , utilization management, or potential quality issues * Knowledge… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... the safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing… more
- Elevance Health (Los Angeles, CA)
- ** Nurse Appeals - Licensed RN Nurse...forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet ... locations. **Shift:** Monday to Friday from 8:00am-5:00pm PST The ** Nurse Appeals ** is responsible for investigating and...skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a… 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. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more