Appeals and Grievances

Appeals and Grievances - RN, Senior at Blue Shield of California summary: The Senior RN in Appeals and Grievances at Medi-Cal oversees clinical reviews of member appeals and grievances related to service and claim denials. This role involves utilizing coverage determination guidelines to assess inpatient and outpatient Medicare member appeals for...

Appeals and Grievances - RN, Senior at Blue Shield of California summary: The Senior Appeals and Grievances RN is responsible for clinically reviewing member appeals and grievances related to preservice, post-service, and claim denials. This role requires proficiency in Medicare and Medi-Cal guidelines, including the National Coverage Determination and...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your RoleThe Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your RoleThe Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your RoleIs this your next job Read the full description below to find out, and do not hesitate to make an application.The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Grievance and Appeals Nurse - Hybrid HealthCare Support is actively seeking a Grievance and Appeals Nurse - Hybrid to fill an opening with a Fortune top 25 Managed Care Company in Rancho Cucamonga, CA 6 month contract, eligible to apply to internal positions after 6 month contract is complete M-F 8am-5pm. Hybrid, after training will work from home 2 days a...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Job DescriptionThe Grievance and Appeals Nurse - Hybrid will be responsible for investigating member grievances, ensuring accurate case coding, and coordinating care with various practitioners and providers. This involves working closely with the Grievance and Appeals Team under the direction of the Grievance Nurse Leadership to ensure all member grievance...

Company OverviewIn the pursuit of delivering exceptional patient care, HealthCare Support is seeking a skilled Grievance and Appeals Nurse - Hybrid to join their team. As a leading provider of healthcare staffing solutions, we take pride in our commitment to excellence and patient-centered care.This full-time position offers a unique opportunity for a...

Job OverviewWe are seeking a skilled Clinical Review Specialist to join our Medi-Cal Appeals and Grievances team. This role involves performing accurate and timely clinical reviews of member appeals and grievances, ensuring compliance with National Coverage Determination (NCD) guidelines and other relevant regulations.The successful candidate will have...

About this RoleThe Grievance and Appeals Nurse serves as a key liaison between the company, IPAs, hospitals, and other stakeholders to ensure that grievances and appeals are processed efficiently and in accordance with regulatory guidelines. This role involves coordinating care with members, PCPs, and IPAs to provide continuous quality care and assist in the...

Required Skills and QualificationsTo succeed in this role, candidates must possess a high school diploma or equivalent, an active LVN license in CA, and at least 2+ years of experience in Case Management, Grievances and Appeals, and/or Utilization Management from an MCO setting. Additionally, they must have a valid California Driver's License and knowledge...