- UCLA Health (Los Angeles, CA)
- Description As the Appeals & Grievances Nurse , you will play a key role in managing and resolving New Century Health Plan member appeals and ... or Medicare Advantage setting is highly desired * Experience in handling appeals , grievances , utilization management, or potential quality issues * Knowledge… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... the safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing… more
- Molina Healthcare (TX)
- …opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational Nurse ... (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license. + OR Bachelor's or master's degree in Nursing, Gerontology, Public Health, Social Work, or related field. **Required Experience** + 5+ years of managed healthcare experience,… more
- Elevance Health (Walnut Creek, CA)
- ** Nurse Appeals - Licensed RN Nurse...forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet ... locations. **Shift:** Monday to Friday from 8:00am-5:00pm **PST** The ** Nurse Appeals ** is responsible for investigating and...skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a… more
- VNS Health (Manhattan, NY)
- …opportunity to: * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare ... high standards for operational and regulatory compliance in managing grievances and appeals on our behalf. *...and current registration to practice as a registered professional nurse in New York State required Education: + Associate's… more
- TEKsystems (Rancho Cucamonga, CA)
- Grievance & Appeals Nurse (Hybrid - Rancho Cucamonga, CA) Pay: $31/hr Location: Hybrid - Rancho Cucamonga, CA 91730 Are you a dedicated Licensed Vocational ... to make an impact? We're hiring a Grievance & Appeals Nurse to ensure that healthcare cases...(CMS, DHCS, DMHC, NCQA). + Review and resolve medical grievances and coordinate care with providers. + Investigate quality-of-care… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances , appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare ... each grievance or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with… more
- The Cigna Group (Nashville, TN)
- …in Medicare Part C + Ability to differentiate different types of requests Appeals , Grievances , coverage determination and Organization Determinations in order to ... Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst We...Additional duties as assigned. Qualifications + Education: Licensed Practical Nurse (LPN) or Registered Nurse (RN) +… more
- Baylor Scott & White Health (Temple, TX)
- …and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal ... ROLE** + Maintains data entry requirements for all complaints, appeals and grievances . + Builds case files...case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy Technicians for handling where required.… more
- Sacramento County (Sacramento, CA)
- Nurse Practitioner Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1780920) Apply Nurse Practitioner Salary $127,576.80 - $155,096.64 ... on: 9/27/2024, 10/25/2024, 11/22/2024, 12/27/2024, 1/31/2025, 2/28/2025, 3/28/2025, 4/25/2025 Nurse Practitioners provide a range of health care services involving… more