- Elevance Health (Woodland Hills, CA)
- ** Nurse Appeals - Licensed Nurse ** **Location:** *The ideal candidate must reside in the state of California and live within 50 miles of our Woodland Hills ... **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and...which would provide an equivalent background. Current active unrestricted RN license to practice as a health professional within… more
- Elevance Health (Woodland Hills, CA)
- ** Nurse Appeals - California candidates only** **Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health ... make an impact:** Responsible for investigating and processing and medical necessity appeals requests from members and providers. **Primary duties may include, but… more
- Elevance Health (Woodland Hills, CA)
- The Nurse Medical Mgmt I is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to ... in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Primary duties may include, but are not limited to:… more
- Prime Healthcare (Ontario, CA)
- …Utilization Review or Case Management with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA) certificate upon hire and maintain ... Service, to provide guidance on complex Authorizations, Referrals, Denials and Appeals . + Integrates and coordinates services using continuous quality improvement… more