- Baylor Scott & White Health (Temple, TX)
- …may vary based on position type and/or level **JOB SUMMARY** **HYBRID POSITION** The Appeals & Grievances (Medical Auditor ) RN conducts reviews of medical ... of services. **ESSENTIAL FUNCTIONS OF THE ROLE** + Reviews clinical information for appeals and grievances (pre- and post-service denials) utilizing… more
- Healthfirst (NY)
- **Duties and Responsibilities:** + Conduct quality audits of A&G items including grievances , pre-service appeals , and post service appeals utilizing ... and performance to ensure quality. + Review and investigate appeals and grievances requests to ensure all...to ensure audits and reports are value-added + Applies clinical and critical thinking skills to evaluate the quality… more
- Molina Healthcare (Mesa, AZ)
- …department. We are seeking a Registered Nurse with previous Appeals and Grievances experience and a clinical background. The candidate must have strong ... are maintained + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment… more
- Dignity Health (Bakersfield, CA)
- …manner to the health plan. - Partners as needed with the appeals and grievances functions of the department. **Qualifications** **Minimum Qualifications:** ... Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a… more