- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal and Grievance Nurse is responsible for conducting daily ... in a quality-focused, production-driven environment. The position reports directly to the Clinical Appeal Manager. Note: This job description is not intended… more
- Fallon Health (Worcester, MA)
- …the application of clinical criteria and medical necessity determinations. The Appeal Nurse is responsible for ensuring compliance with all applicable state ... regulatory requirements and member expectations. Under the direction of the Director, the Appeal Nurse represents, manages and oversees second level appeal … more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... culturally-appropriate manner. Coordinates, tracks, and resolves internal and external appeal and grievance complaints for LA Care...on strategic opportunities to improve the overall appeals & grievance process. Create a best in clinical … more
- The County of Los Angeles (Los Angeles, CA)
- …as needed. + Evaluates the performance of subordinates and resolves problems involving grievance and discipline. + Advises nurse managers and other nursing staff ... of experience in nursing management at the level of Nurse Manager** or higher in a clinical ...for a late test administration, re-scheduling, or extension of appeal rights period. + I understand the above information… more
- AdventHealth (Minneola, FL)
- …charm and friendly atmosphere makes this an exceptional destination. This community's appeal continues to grow as exciting new developments are underway near the ... general medical/surgical rooms. We are proud to be delivering clinical solutions for the mind, body and spirit in...activities, including the internal event report system and patient grievance process are in compliance with FL State Statute… more
- State of Colorado (Pueblo, CO)
- …CAA P/T 3557 Physician 5/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 05/12/2025 Closing Date 10/16/2025 4:00 ... on-call assessment, diagnosis, and treatment of inmates in one or more prison clinical settings. Physicians are responsible for, but not limited to, the following: +… more