- Centene Corporation (New York, NY)
- … appeals and grievances from a clinical perspective. Ensure that the clinical Appeals and Grievance department processes all cases in accordance with ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- LA Care Health Plan (Los Angeles, CA)
- …the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Licensed Registered Nurse ( RN ) - Active, current and ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC ...assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical … more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & ... & grievance process. Create a best in clinical appeals process that is efficient and...Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Elevance Health (Mason, OH)
- **Manager II Grievance / Appeals - RN ** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Hills ( _Must be within commutable distance to one of the ... is granted as required by law._ The **Manager II Grievance / Appeals ** is responsible for management oversight of...clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and… more
- Elevance Health (Cleveland, OH)
- ** Nurse Appeals -Licensed Nurse ** **Location** : Ohio, candidates must be residents of Ohio to be considered. **Hybrid 1** : This role requires associates to ... necessary and is dependent on court hearing schedules. The Nurse Appeals is responsible for investigating and...directors and consultants; preparing recommendations to uphold or deny appeals ; and ensuring all grievance processes are… more
- AmeriHealth Caritas (Philadelphia, PA)
- …process, preferably within a managed care organization **Licensure:** + Current and unrestricted Registered Nurse ( RN ) licensure or compact state licensure ... **Role Overview: ;** The Clinical Appeals Reviewer is responsible for...Committee Quality Assurance (NCQA) standards related to appeal and grievance operations **Education & Experience:** + Bachelor's degree (BSN)… more
- Elevance Health (Columbus, OH)
- ** Nurse Appeals RN ** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Fields _(Must be within commutable distance to the listed locations.)_ ... for employment, unless an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and processing and medical… more
- Elevance Health (Tampa, FL)
- ** Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... for employment, unless an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and processing and medical… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …and Management Team + Legal Department: + Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare Advantage, and InterPlan Program) + ... the Peer Review Specialist works closely with CPR's Director and Clinical Lead, Operations Lead, Senior Credentialing Manager/ Compliance Consultant, Risk… more