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...

HealthCare Support is seeking a skilled Grievance and Appeals Nurse to join our team. As a Grievance and Appeals Nurse, you will work closely with our Grievance and Appeals Team to investigate and resolve member grievances in a timely and effective manner. Your responsibilities will include reviewing case coding, assisting in the resolution of member medical...

Grievance and Appeals Nurse - Hybrid Job DescriptionWe are seeking a skilled Grievance and Appeals Nurse - Hybrid to join our team at HealthCare Support. 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 in a timely and effective manner.Key...

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...

About the RoleWe are seeking a highly skilled Appeals and Grievances Representative to join our team at Blue Shield of CA. As a key member of our Medi-Cal Appeals and Grievance team, you will be responsible for researching and resolving member grievances, appeals, and interpreting health plan benefits, policies, and procedures.Key ResponsibilitiesAssist with...

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...

Your RoleAs a key member of the Blue Shield of CA team, you will play a critical role in ensuring that our members receive the highest level of service and support. The Appeals and Grievances Representative will be responsible for researching and resolving member grievances and appeals, as well as interpreting and explaining health plan benefits, policies,...

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 an Advanced Provider Dispute Resolution Coordinator to join our Provider Dispute Resolution Team. As a key member of our team, you will be responsible for researching, reviewing, and resolving high-level/high-priority provider grievances, appeals, and complaints.Key ResponsibilitiesProcess provider appeals and correspondence with...

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 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...