Grievance Resolution Nurse

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...

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...

Job Description:We are seeking a Senior Behavioral Health Case Manager to join our team at Blue Shield of California. As a key member of our care management team, you will play a vital role in providing high-quality care to our members.About the Role:This is a permanent position that requires a Bachelor's degree in Nursing and current RN licensure. The ideal...

Job SummaryWe are seeking a highly skilled Nurse Case Manager to join our team in the outpatient setting. As a Senior Care Manager, you will play a pivotal role in coordinating and managing patient care services, ensuring continuity of care and compliance with clinical guidelines.About the RoleThis position requires a strong clinical background, excellent...

Job SummaryWe are seeking a highly skilled and experienced Healthcare Manager to join our team at Blue Shield of California. This role involves providing integrated case management and disease management activities, demonstrating clinical judgment and independent analysis, and collaborating with members and healthcare professionals.About the RoleThe...

Senior Nurse Care Coordinator Role OverviewWe are seeking a highly skilled and experienced Senior Nurse Care Coordinator to join our team at Blue Shield of California.About the Role:Coordinate and manage patient care services in outpatient settings, designing and implementing individualized care plans while ensuring continuity of care and compliance with...

About This RoleWe are seeking a highly skilled Senior Care Manager to join our Care Management team at Blue Shield of California. As a key member of our team, you will play a pivotal role in coordinating and managing patient care services in outpatient settings.Key ResponsibilitiesDesign and implement individualized care plans that ensure continuity of care...

At Blue Shield of California, we are dedicated to providing exceptional care management services to our members. We are seeking a highly skilled and compassionate Healthcare Specialist - Care Management to join our team.About the RoleThis role will be responsible for ensuring that our members receive high-quality, cost-effective healthcare services. You will...

About the JobWe are seeking a highly skilled Nurse Care Specialist to join our team at Eisenhower Health. In this critical role, you will provide exceptional patient care and contribute to the delivery of high-quality healthcare services.Job DescriptionJob Summary: As a Nurse Care Specialist, you will assess patients' needs, develop individualized care...

About Us">Blue Shield of CA is a leader in healthcare innovation, dedicated to improving the health and well-being of our community. Our team of experts works tirelessly to develop and implement cutting-edge solutions that meet the evolving needs of our members.Salary Range">The salary range for this role is $87,230 - $130,900, based on industry standards...

Company OverviewAveanna Healthcare is a leading provider of home healthcare services, dedicated to delivering exceptional care and compassion to our patients and their families.SalaryThe estimated salary for this position is $31.50 per hour, reflecting the company's commitment to fair compensation and professional development opportunities.Job DescriptionWe...

Job OverviewWe are seeking a skilled Medical Director, Behavioral Health to join our team at Blue Shield of California. In this role, you will play a critical part in ensuring that we provide high-quality behavioral health services to our members.About the RoleThe Medical Director, Behavioral Health will report to the Senior Medical Director, Behavioral...

About the RoleWe are seeking a highly skilled and experienced Senior Medical Director, Behavioral Health to join our team at Blue Shield of California. As a key member of our Medical Management team, you will play a vital role in ensuring that we are on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based...

Job DescriptionJob DescriptionTemporary Coordinator – Grievance and Appeals (Bilingual Spanish)Location: Rancho Cucamonga, CA (Hybrid)Pay Rate: $23.98/hourDuration: 6-Month AssignmentAbout the RoleLooking for an opportunity to make an impact? TEKsystems is hiring a Temporary Coordinator – Grievance and Appeals (Bilingual Spanish) to join our team....

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 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 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...

Make a Difference on Your Own Schedule and Terms!Hiring Senior Case Managers in New Mexico   Come join our growing team! A few of our perks:Create your own schedule!$42/hr. (including 100% of Hourly Wage Paid for All Drive Time)Bonus Eligible Direct assigned team members of RN Case Managers in the provision of care in accordance with Agency policy and...

Your RoleWork schedule is Mon-Fri 10am- 7pmThe Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Regional...

Your Role Work schedule is Mon-Fri 10am- 7pm The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Regional...

Your Role Work schedule is Mon-Fri 10am- 7pm The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Regional...

Your Role Work schedule is Mon-Fri 10am- 7pm The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Regional...

Your Role Work schedule is Mon-Fri 10am- 7pm The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Regional...

Your Role Work schedule is Mon-Fri 10am- 7pm The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Regional...

Your Role Work schedule is Mon-Fri 10am- 7pm The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Regional...