- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, June 3, 2024 Centers Plan for Healthy Living's ... 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
- CVS Health (Columbus, OH)
- …for medical director reviews A Brief OverviewAdministers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical ... implement best in class policies, plans, and procedures in support of the Appeals area objectives.Executes review of all clinical and benefit documentation for… more
- Elevance Health (Rancho Cordova, CA)
- ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live in the state ... our PulsePoint locations. **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and processing and medical… more
- Elevance Health (Hendersonville, TN)
- ** Nurse Appeals - Licensed Nurse ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live in the state of ... or Louisiana within 50 miles of one of our PulsePoint locations. The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This ... and Complex Care Needs. Essential Qualifications + Current licensed Registered Nurse ( RN ) with state...within managed care setting. + 3+ years' experience in clinical nurse setting preferred. + Grievance… more
- HCA Healthcare (Asheville, NC)
- …for over sight of the Contract Liaison, HIMS Clerk and Service Delivery, Appeals and Grievance (SDAG) Coordinator. Essential Accountabilities: + Develops and ... (5) years of relevant experience in health related field. **Preferred Education:** Clinical training and licensure **Preferred License:** RN , PT, SW **Required… more