- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & ... & grievance process. Create a best in clinical appeals process that is efficient and...Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Management (UM) services to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal and Grievance Nurse is responsible for ... Appeals regulatory guidelines including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals , Utilization Review, and Grievance processes including… 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
- AmeriHealth Caritas (Philadelphia, PA)
- …process, preferably within a managed care organization **Licensure:** + Current and unrestricted Registered Nurse ( RN ) licensure or compact state licensure ... **Role Overview: ;** The Clinical Appeals Reviewer is responsible for...Committee Quality Assurance (NCQA) standards related to appeal and grievance operations **Education & Experience:** + Bachelor's degree (BSN)… more
- Elevance Health (Atlanta, GA)
- ** Nurse Appeals ** **Location:** This role enables associates...or BS in Nursing preferred. + 3 years of clinical experience as a Registered Nurse ... 8-hour shift between those hours, including holidays on a rotational basis. The ** Nurse Appeals ** is responsible for investigating and processing and medical… 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