- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances ... net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General...Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Elevance Health (Costa Mesa, CA)
- ** Nurse Appeals RN -Quality of...of Care cases. + Reviews medical records for member grievance concerns and Quality of Care cases. + Extrapolates ... **Expected Work Hours:** Monday-Friday, 8:00AM -5:00 PM Pacific Standard Time The ** Nurse Appeals ** is responsible for investigating and processing and medical… more
- Elevance Health (Metairie, LA)
- ** Nurse Appeals RN -Quality of...of Care cases. + Reviews medical records for member grievance concerns and Quality of Care cases. + Extrapolates ... **Expected Work Hours:** Monday-Friday, 8:00AM -5:00 PM Eastern Standard Time The ** Nurse Appeals ** is responsible for investigating and processing and medical… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal and Grievance Nurse is responsible for conducting daily clinical and ... environment. The position reports directly to the Clinical Appeal Manager . Note: This job description is not intended to...including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals , Utilization Review, and Grievance processes including… more
- Elevance Health (Atlanta, GA)
- ** Nurse Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... those hours, including holidays on a rotational basis. The ** Nurse Appeals ** is responsible for investigating and...preferred. + 3 years of clinical experience as a Registered Nurse is strongly preferred. + Experience… more
- Elevance Health (Charlotte, NC)
- ** Nurse Appeals - Litigation & Legal Support** **Location:** North Carolina, candidates must be residents of North Carolina to be considered. **In Office ... necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support**...directors and consultants; preparing recommendations to uphold or deny appeals ; and ensuring all grievance processes are… more
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