Grievance and Appeals Nurse

Job SummaryWe are seeking a highly skilled Grievance and Appeals Nurse to join our team at Alura Workforce Solutions. The successful candidate will be responsible for working directly with IPAs, hospitals, internal departments, and the grievance team to ensure grievance and appeal cases are processed in accordance with our Grievance Policy & Procedures and...

Grievance and Appeals Nurse - Hybrid Job SummaryHealthCare Support is seeking a Grievance and Appeals Nurse - Hybrid to fill an opening with a Fortune top 25 Managed Care Company in Rancho Cucamonga, CA. This is a 6-month contract position, with the possibility of transitioning to an internal role after completion. The successful candidate will work Monday...

Grievance and Appeals Nurse - Hybrid PositionHealthCare Support is seeking a skilled Grievance and Appeals Nurse to fill a hybrid role with a top 25 Managed Care Company in Rancho Cucamonga, CA.Key Responsibilities:Work closely with the Grievance and Appeals Team to investigate and resolve Member grievances.Review case coding and assist in the resolution of...

Your Role:As a Clinical Appeals and Grievances Specialist at Blue Shield of California, you will be responsible for reviewing member appeals and grievances related to Medicare and Medi-Cal benefits. This role requires a strong understanding of clinical guidelines, including National Coverage Determination (NCD) and Local Coverage Determination (LCD)...

About the RoleThe Medical Director, Utilization Management plays a critical role in ensuring the delivery of high-quality, cost-effective healthcare services to our members. As a key member of the Blue Shield of California Medical Management team, you will be responsible for reviewing and making determinations regarding member and provider requests for...

Job SummaryThe Medical Director, Utilization Management will serve as a key member of the Blue Shield of California Promise Health Plan's utilization management review team. This role reports to the VP, Medical Management or their designee.Key ResponsibilitiesReview and make determinations regarding all member and provider requests for service, including...

Your RoleThe Medical Management team at Blue Shield of California is dedicated to ensuring that our organization is at the forefront of medical, medication, and payment policy to accelerate the emergence of a value-based healthcare system in California. As the Medical Director, Utilization Management (CalPERS), you will report to the Vice President, Medical...

Job SummaryThe Senior Utilization Management Nurse will be responsible for reviewing inpatient stays for our members under nationally recognized levels of care guidelines. This role requires a strong clinical background and excellent analytical skills to determine medical necessity of admissions, appropriate length of stay, and level of care.Key...

Job SummaryThis role is part of the Care Management team at Blue Shield of California, supporting the mission of providing support to patients in maintaining health and wellness in the outpatient setting. As a Senior Care Manager, you will ensure that services are provided based on standardized procedures, including coordination of care with specialists,...

Job SummaryThe Senior Utilization Management Nurse will be responsible for performing first-level determination approvals for members using BSC evidenced-based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business such as Medicare. This role requires a strong clinical judgment and...

Job SummaryThe Senior Utilization Management Nurse will play a key role in ensuring that members receive high-quality, cost-effective care. This position will be responsible for performing first-level determination approvals for members using BSC evidenced-based guidelines, policies, and nationally recognized clinical criteria.Key ResponsibilitiesPerform...

Your RoleThe Care Management team at Blue Shield of California aims to support the mission of the department, which is to provide care and support to patients in maintaining health and wellness in the outpatient setting.In this role, you will work closely with the Manager of Care Management to ensure that services are provided based on standardized...

Job SummaryWe are seeking a skilled and compassionate Registered Nurse to join our team in providing high-quality hospice care to patients and their families. The ideal candidate will have a strong background in nursing, with a focus on community health education and experience in hospice care.Key ResponsibilitiesConduct comprehensive assessments of patients...

Job DescriptionJob Title/Position: Nurse Care SpecialistReports To: Clinical Supervisor/Nursing SupervisorJOB DESCRIPTION SUMMARYThe nurse care specialist plans, organizes, and directs home care services, emphasizing community health education and experience. This professional builds from the resources of the community to plan and direct services to meet the...

Rancho Mirage Health and Rehabilitation Center seeks a skilled Licensed Vocational Nurse to provide high-quality nursing care to our residents.Responsibilities:Deliver routine daily nursing care to residents in accordance with federal, state, and local standards.Monitor and record vital signs, dress wounds, and perform other essential nursing...

Job DescriptionYour RoleThe Medical Care Solutions education team is responsible for all clinical education for all departments within Medical Care Solutions as well as some Health Solutions teams. This includes Utilization Management, Care Management, Post Service, and Appeals. This clinical educator role will be responsible for Utilization Management for...

Job SummaryThe Licensed Vocational Nurse will provide routine daily nursing care to residents in accordance with federal, state, and local standards. This role requires a strong commitment to delivering high-quality patient care and working collaboratively with the healthcare team.Key ResponsibilitiesEnsure all nursing care is provided in a private and...

Job SummaryThe Certified Nursing Assistant (CNA) position at Rancho Mirage Health and Rehabilitation Center is responsible for providing routine daily nursing care to residents in accordance with their assessment plan and facility standards. The CNA will work under the supervision of licensed nurses to ensure the highest level of care is provided to our...

Job Title:Occupational Health Practitioner - Physician Assistant or Nurse PractitionerJob Summary:CareOnSite is seeking a highly skilled Occupational Health Practitioner to join our team. As a Physician Assistant or Nurse Practitioner, you will provide in-person occupational health services to the community, performing therapeutic and minor surgical...

Job Opportunity: Prime HealthCare Staffing is seeking an experienced Occupational Therapist for a travel contract opportunity in a Skilled Nursing Facility setting. As a therapist, you will manage a treatment plan to promote a positive outcome for patients with diverse diagnoses. The schedule can be 8-10 hour shifts, 4-5 days a week. One year of recent...