Grievance and Appeals Nurse

Job SummaryWe are seeking a highly skilled and experienced Grievance and Appeals Nurse to join our team at Alura Workforce Solutions. As a key member of our healthcare team, you will be responsible for ensuring that grievance and appeal cases are processed in accordance with regulatory guidelines and company policies.Key ResponsibilitiesWork closely with...

Grievance and Appeals Nurse - Hybrid Job DescriptionHealthCare Support is seeking a skilled Grievance and Appeals Nurse - Hybrid to join their team. This role involves working closely with the Grievance and Appeals Team to ensure all member grievance issues are investigated and resolved appropriately.Daily Responsibilities:Work with the Grievance and Appeals...

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...

HealthCare Support is seeking a skilled Grievance and Appeals Nurse to join our team. As a key member of our team, you will work closely with the Grievance and Appeals Team to ensure all Member grievance issues are investigated and resolved appropriately. Your responsibilities will include reviewing case coding, assisting in the resolution of Member medical...

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...

About the RoleThe Appeals and Grievances team at Blue Shield of California is seeking a skilled RN Senior to join our team. As a Clinical Reviewer, you will play a critical role in ensuring that member appeals and grievances are handled in a timely and accurate manner.Key ResponsibilitiesConduct thorough clinical reviews of member-initiated appeals and...

About the RoleWe are seeking a skilled Clinical Reviewer to join our Appeals and Grievances team at Blue Shield of California. As a key member of our team, you will play a critical role in ensuring that our members receive high-quality care and that our clinical decisions are informed by the latest evidence-based guidelines.Key ResponsibilitiesConduct...

About the RoleWe are seeking a highly skilled Medical Director, Utilization Management to join our team at Blue Shield of California. As a key member of our Medical Management department, you will play a critical role in ensuring our members receive the right level of care, at the right time, and at the right cost.Key ResponsibilitiesReview and make...

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...

About Our FirmMastagni Holstedt, A Professional Corporation, is a leading law firm in California, serving clients in various legal matters, including labor and employment, contract negotiations, criminal defense, personal injury, auto accidents, medical malpractice, and workers' compensation.Job SummaryWe are seeking a highly qualified Associate Attorney to...

About the RoleWe are seeking a highly skilled Medical Director, Utilization Management to join our team at Blue Shield of California. As a key member of our Medical Management department, you will play a critical role in ensuring our Medi-Cal members receive the right level of care, at the right time, and at the right cost.Key ResponsibilitiesReview and make...

About Our FirmMastagni Holstedt, A.P.C. is a leading law firm in California, serving clients in a wide range of legal matters, including labor and employment, contract negotiations, criminal defense, personal injury, auto accidents, medical malpractice, and workers' compensation.Job SummaryWe are seeking a highly qualified Associate Attorney to join our...

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 SummaryWe are seeking a highly skilled Medical Director, Operations to join our team at Blue Shield of California. As a key member of our Medical Management department, you will play a critical role in ensuring our members receive the right level of care, at the right time, and at the right cost.Key ResponsibilitiesReview and make determinations...

Job Title: Medicare Prior Authorization RNAt Blue Shield of California, we are seeking a skilled and experienced Medicare Prior Authorization RN to join our Utilization Management team. As a key member of our team, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.Key Responsibilities:Conduct thorough...

Job SummaryBlue Shield of California is seeking a highly skilled Medical Director, Utilization Management to join our team. As a key member of our Medical Management department, you will play a critical role in ensuring our Medi-Cal members receive the right level of care, at the right time, and at the right cost.The ideal candidate will have a strong...

Job Title: Assistant ManagerJob Summary:Abercrombie & Fitch Co. is seeking a highly motivated and experienced Assistant Manager to join our team. As an Assistant Manager, you will be responsible for driving sales results, providing best-in-class customer service, and overseeing daily store operations.Key Responsibilities:Customer Experience: Ensure that...

About the RoleThe Utilization Management Nurse, Senior will play a critical role in ensuring the quality and appropriateness of care for our members. As a key member of the Utilization Management team, you will be responsible for reviewing inpatient stays to determine medical necessity and level of care.Key ResponsibilitiesPerform prospective utilization...

About the RoleBlue Shield of California is seeking a highly skilled Senior Care Manager to join our team. As a key member of our Care Management team, you will play a critical role in supporting the mission of our department, which is to provide exceptional care and support to patients in the outpatient setting.Key Responsibilities:Develop and implement...