- Henry Ford Health System (Troy, MI)
- …prompt and thorough investigation of medical, transportation, and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare ... + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center...At least two (2) years of member appeal and grievance experience . + Minimum of two (2) years… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound clinical judgement to ... integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a...to assist with medical necessity determinations. Key Qualifications: + Registered Nurse or Licensed Practical Nurse… more
- LA Care Health Plan (Los Angeles, CA)
- …purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to ... Customer Solution Center Appeals and Grievances Nurse Specialist RN...agencies. Good working knowledge of regulatory requirements/standards. Licenses/Certifications Required Registered Nurse (RN) - Active, current and… more
- CDPHP (Albany, NY)
- …, grievances, NYS external review, and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse Practitioner, with ... to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider...is responsible for adhering to a member/provider appeal and grievance process that meets state, federal, accreditation and other… more
- The Cigna Group (Bloomfield, CT)
- …activities as needed. + Additional duties as assigned. **Qualifications** + Education: Licensed Practical Nurse (LPN) or Registered Nurse (RN) + 3-5 years' ... with every other weekend (Tuesday ALT Day).** + Must have experience in Medicare Appeals , Utilization Case Management or Compliance in Medicare Part C + Ability to… more