- 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)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II… 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
- VNS Health (Manhattan, NY)
- OverviewManages the day to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans product lines - Managed Long ... management of clinical appeals review processes within Appeals & Grievances Department. + Manages the...and current registration to practice as a registered professional nurse in New York State required Education: + Associate's… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances , appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare ... each grievance or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with… more
- Baylor Scott & White Health (Temple, TX)
- …and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal ... ROLE** + Maintains data entry requirements for all complaints, appeals and grievances . + Builds case files...case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy Technicians for handling where required.… more
- CDPHP (Albany, NY)
- …This individual will be responsible for tracking, trending and monitoring of appeals , grievances , NYS external review, and making recommendations for change. ... to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider...QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse Practitioner, with… more
- Sacramento County (Sacramento, CA)
- Nurse Practitioner Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1780920) Apply Nurse Practitioner Salary $127,576.80 - $155,096.64 ... on: 9/27/2024, 10/25/2024, 11/22/2024, 12/27/2024, 1/31/2024, 2/28/2024, 3/28/2024, 4/25/2024 Nurse Practitioners provide a range of health care services involving… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …review of services and care. * Provides referrals to Case management, Disease Management, Appeals & Grievances , and Quality Departments as needed. * Develop and ... provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews on prior… more
- State of Colorado (Canon City, CO)
- …reviews, and completing performance evaluations per CDOC regulations, and resolves complaints/ grievances at the informal level; + Ensures staff compliance with the ... daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints/ grievances at the informal level, responsibility for scheduling and… more
- Molina Healthcare (Phoenix, AZ)
- …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
- State of Colorado (Limon, CO)
- …nebulizer treatments, eye/ear irrigations; + Assist physicians, physician assistants, and nurse practitioners with minor medical and surgical procedures; + May ... supplies for store rooms and examination rooms; + Coordinate grievances by logging and mailing back responses. Complete flow...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- BlueCross BlueShield of North Carolina (NC)
- …healthcare services provided to Plan members + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care + ... Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial process + Educates and… more
- VNS Health (Manhattan, NY)
- …the administration of all BH QM/UM and performance improvement activities, encompassing grievances and appeals , and contributes to various other subcommittees ... State or other independent licensure (LMHC, LMFT, clinical psychologist, or psychiatric Nurse Practitioner). required + Licensure in other states is an additional… more