- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Tuesday, November 5, 2024 Centers Plan for Healthy ... plans they need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex...in writing. + Analyze and complete written summaries on clinical cases. EDUCATION AND EXPERIENCE: Education: RN … more
- CareFirst (Baltimore, MD)
- …process for our membership, and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an ... in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse -... Consultant, Utilization Management, and Government Program experience with Appeals and Grievance , Experience with MCG, InterQual,… more
- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals ( RN )to lead the daily operations of our ... direct oversight and the day to day management of clinical appeals review processes within Appeals...+ License and current registration to practice as a registered professional nurse in New York State… more
- Commonwealth Care Alliance (Boston, MA)
- …to appeal and grievances. **What You'll Be Doing:** - Processing of Grievances & Appeals . - Responsible for the progress of grievance and appeal intervention and ... strict deadlines. - When necessary collaborate with care teams, clinical staff, family members, and other involved in providing...dental, reporting, and member services. - Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor ( RN ) directs and coordinates the accurate implementation of the clinical appeal ... and serves as a resource for associates within the Clinical Appeals and Analysis unit supporting Government...**Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse -… more
- Elevance Health (Walnut Creek, CA)
- **Manager II Grievance / Appeals ( RN )-California** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live ... + **Palo Alto** + **Walnut Creek** The **Manager II Grievance / Appeals ** is responsible for management oversight of...clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and… more
- Elevance Health (Los Angeles, CA)
- ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the ... our PulsePoint locations. **Shift:** Monday to Friday from 8:00am-5:00pm PST The ** Nurse Appeals ** is responsible for investigating and processing medical… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes ... regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes ...**Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse -… more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity...external review, and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse… more
- CareOregon (Medford, OR)
- … RN license in the State of Oregon + Minimum 2 year experience as a Registered Nurse ( RN ) in the healthcare industry + Valid driver's license, acceptable ... and must comply with all federal laws. Job Title Registered Nurse - Care Coordinator (Community) Exemption...For Service program benefits). + Report member complaints to Appeals and Grievance team for investigation and… more