- 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 ... Nurse (LVN) looking to make an impact? We're hiring a Grievance & Appeals Nurse to ensure that healthcare cases are processed with the highest level of… 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 ... grievance and appeals processes. You will play a crucial role in...and current registration to practice as a registered professional nurse in New York State required Education: + Associate's… more
- VNS Health (Manhattan, NY)
- …criteria. + Enters data and assists with compiling reports and analysis on the grievance and appeals process. + Participates in special projects and performs ... and current registration to practice as a registered professional nurse in New York State required Education: + Bachelor's...care, including a minimum of two years in a grievance and appeals or related area such… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for...case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy Technicians for handling where required.… more
- Elevance Health (Walnut Creek, CA)
- ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the state of ... our PulsePoint locations. **Shift:** Monday to Friday from 8:00am-5:00pm **PST** The ** Nurse Appeals ** is responsible for investigating and processing medical… more
- The Cigna Group (Nashville, TN)
- Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst We will depend on you to communicate some of our most critical information to the correct ... individuals regarding Medicare appeals and related issues, implications and decisions. The Case...Director. + Determine whether additional pre service, appeal or grievance reviews are required and/or whether additional appeal rights… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …and actively participates in the functioning of the plan's grievance and appeals processes. + Along with the nurse supervisor and manager identify ... care to ensure quality, cost-efficiency and continuity of care; Informs the UR Nurse of certification decisions within appropriate time frames as guided by URAC,… more
- HCA Healthcare (Rochester, NH)
- …At Frisbie Memorial Hospital, our nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want to create your own personal career ... payors, and hospital-negotiated contracts. Assists medical staff in responding to appeals . Provides requested information regarding patient care and services to… more
- State of Colorado (Canon City, CO)
- …at the informal level; + Ensures staff compliance with the offender grievance process, offender co-pay, electronic data entry, and information systems requirements; ... Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel...license from the State of Colorado as a Registered Nurse or Nurse Practitioner? + Yes +… more
- Kelsey-Seybold Clinic (Houston, TX)
- …determined within appropriate timeframes. This position will serve as a liaison to the Grievance and Appeals Department for Medicare Advantage appeals . The ... work experience, certifications, etc.)** **Qualifications** **Education** Required: Licensed Vocational Nurse ; CEU requirement Preferred: Certification in area of specialization… more