- 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 state of ... 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 ... or Medicare Advantage setting is highly desired * Experience in handling appeals , grievances, utilization management, or potential quality issues * Knowledge of… 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, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the overall… 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, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- Adecco US, Inc. (Los Angeles, CA)
- Adecco Healthcare & Life Sciences is hiring an Appeals Pharmacist. This role is remote / work from home. Please read below and apply with an updated resume for ... to 5pm PST **Pay:** $70.00 to $73.00 an hour **Responsibilities of the Appeals Pharmacist:** . Collaborates with the coordinators and nurses to process referrals,… more
- Select Medical (Los Angeles, CA)
- …City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) **Pay Rate: $50 - $58.65 depends ... overseeing negotiations of continued stay rationale, length of stays, and appeals process. Initiates activities to develop positive business relationships with… more
- UCLA Health (Los Angeles, CA)
- …Criteria + Experience with Flesch-Kincaid readability scoring + Knowledge of the appeals process + Experience with audit preparation + Basic computer skills UCLA ... Health is a world-renowned health system with four award-winning hospitals and more than 250 community clinics throughout Southern California as well as the David Geffen School of Medicine. Through the efforts of our outstanding people, we have become Los… more
- Providence (Mission Hills, CA)
- …California Region. The Manager assists the Regional Director of Utilization Management, Appeals & Clinical Training through the provision of ongoing assessment and ... Degree in Nursing or other related area + Upon hire: California Registered Nurse License + 5 years Healthcare management experience related to acute care utilization… more