Nurse Appeals Specialist
4 days ago
We are seeking a skilled Nurse Appeals Specialist to join our team at Elevance Health. As a key member of our quality of care team, you will be responsible for investigating and processing quality of care grievances from members and providers.
Key Responsibilities- Conduct thorough investigations and reviews of member and provider quality concerns.
- Review prospective, inpatient, or retrospective medical records to identify areas for improvement.
- Extrapolate and summarize medical information for medical directors, consultants, and other external reviewers.
- Prepare recommendations for assigning appropriate levels of care or forward to medical directors for decision-making.
- Ensure timely resolution of grievances to meet regulatory requirements.
- Document and log appeal/grievance information on relevant tracking systems and mainframe systems.
- Generate written correspondence to providers, members, and regulatory entities.
- Utilize leadership skills and serve as a subject matter expert for appeals/grievances/quality of care issues, providing guidance to clinical and non-clinical team members.
- Minimum of 2 years of experience in a managed care healthcare setting or equivalent combination of education and experience.
- Current active unrestricted RN license from the State of California required.
- Preferred qualifications include ER experience, appeals/quality of care experience, managed care experience, and AS or BS in Nursing.
Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution. We are committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
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Technical Content Specialist
5 days ago
Palo Alto, California, United States Skyline Innovations Full timeAbout the RoleWe are seeking a skilled Technical Content Specialist to join our Product Management team at Skyline Innovations. As a key member of our team, you will be responsible for creating high-quality technical documentation that showcases our products in a user-oriented way.Key ResponsibilitiesDevelop and maintain technical documentation for our...
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Nurse Specialist
1 week ago
Palo Alto, California, United States MFS Talent Full timeJob Summary:MFS Talent is seeking a skilled Nurse Specialist to join our team. As a Nurse Specialist, you will be responsible for providing high-quality patient care and ensuring the best possible outcomes for our patients.Key Responsibilities:Assess patients' medical conditions and histories, conduct physical examinations, and order diagnostic tests to...
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Travel Nurse RN Specialist
5 days ago
Palo Alto, California, United States Aureus Medical Group Full timeJob DetailsJob Title: Travel Nurse RN SpecialistJob Type: Travel NursingSpecialty: OncologyLocation: CaliforniaDuration: 15 weeksShift: 12 hours, nightsHours per Week: 36 hoursEmployment Type: TravelJob DescriptionAureus Medical Group - Nursing is seeking a skilled Travel Nurse RN Specialist to join their team in California. As a Travel Nurse RN Specialist,...
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Travel Nurse RN
7 hours ago
Palo Alto, California, United States Medical Solutions Full timeJob Title: Travel Nurse RN - Telemetry SpecialistWe are seeking a skilled Travel Nurse RN - Telemetry Specialist to join our team at Medical Solutions. As a Travel Nurse RN - Telemetry Specialist, you will be responsible for providing high-quality patient care in a telemetry setting.Job Summary:Medical Solutions is a leading provider of total workforce...
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Travel Nurse RN
5 days ago
Palo Alto, California, United States Medical Solutions Full timeJob Title: Travel Nurse RN - Infusion SpecialistJob Summary: Medical Solutions is seeking a skilled travel nurse RN to join our team as an Infusion Specialist. As a travel nurse, you will have the opportunity to work in a variety of healthcare settings and gain valuable experience in a dynamic and fast-paced environment.Responsibilities:Provide high-quality...
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Registered Nurse
1 day ago
Palo Alto, California, United States MFS Talent Full timeAbout the RoleMFS Talent is seeking a highly skilled Registered Nurse to join our team as a Surgical Specialist. As a key member of our healthcare team, you will be responsible for providing exceptional patient care and ensuring the highest standards of surgical excellence.Key ResponsibilitiesAssessment and Diagnosis: Conduct thorough assessments of...
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Travel Nurse RN Oncology Specialist
24 hours ago
Palo Alto, California, United States Cross Country Nurses Full timeJob Title: Travel Nurse RN Oncology SpecialistWe are seeking a skilled Travel Nurse RN Oncology Specialist to join our team at Cross Country Nurses. As a medical/surgical chemotherapy-certified oncology nurse, you will extend care to patients who are receiving chemotherapy treatment for cancer.Key Responsibilities:Assess patients' conditions and start...
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Travel Nurse RN Oncology Specialist
5 days ago
Palo Alto, California, United States Cross Country Nurses Full timeJob Title: Travel Nurse RN Oncology SpecialistJob Summary: Cross Country Nurses is seeking a skilled Travel Nurse RN Oncology Specialist to provide high-quality patient care in a dynamic and challenging environment.Key Responsibilities:Assess patient condition and develop individualized care plans to ensure optimal health outcomes.Administer chemotherapy...
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Travel Nurse RN
7 days ago
Palo Alto, California, United States Aureus Medical Group - Nursing Full timeJob Title: Travel Nurse RN - Oncology SpecialistAureus Medical Group - Nursing is seeking a skilled Travel Nurse RN - Oncology Specialist to join our team for a travel nursing assignment in a reputable healthcare facility.Job Summary:We are looking for a highly motivated and experienced Registered Nurse - Oncology to provide high-quality patient care in a...
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Board-Certified/Board-Eligible OB/GYN Specialist
2 weeks ago
Palo Alto, California, United States Palo Alto Foundation Medical Group Full timePosition Overview:Palo Alto Foundation Medical Group (PAFMG) is in search of a per diem, board-certified or board-eligible OB/GYN specialist.Location:Palo AltoRole Highlights:- Collaborative and physician-led environment- Focus on outpatient and hospital-based OB/GYN care- Manage an average of 20-25 patients daily- Participate in shared call with a...
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Healthcare Nursing Specialist
2 weeks ago
Palo Alto, California, United States Big Bend Woods Healthcare Center Full timeBig Bend Woods Healthcare Center is in search of committed Healthcare Nursing Specialists, specifically Registered Nurses (RNs) and Licensed Practical Nurses (LPNs), to join our outstanding medical team. We are seeking both Full-Time and Part-Time nursing professionals to cover various shifts, including Evening/Night and Day shifts. Reliability and...
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Travel Nurse RN
24 hours ago
Palo Alto, California, United States Medical Solutions Full timeTravel Nurse RN - ER Specialist OpportunityWe are seeking a skilled Registered Nurse (RN) to join our team as an Emergency Room (ER) Specialist in a travel position. As a travel nurse with Medical Solutions, you will have the opportunity to work in a variety of settings and locations, while receiving top-notch support and benefits.Key...
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E-Commerce Product Specialist
2 weeks ago
Palo Alto, California, United States Basket Materials, Inc. Full timeJob OverviewCompany Overview:Basket Materials, Inc. is an innovative startup located in the Bay Area, dedicated to enhancing the recovery of materials and assets for both our clients and the environment. Our goal is to establish ourselves as the premier provider of recycled essential minerals by offering a comprehensive solution for the management of...
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Travel Nurse RN
6 days ago
Palo Alto, California, United States PRN Healthcare Services Full timeJob SummaryWe are seeking a skilled Travel Nurse RN - Infusion Specialist to join our team at PRN Healthcare Services. As a Travel Nurse RN - Infusion Specialist, you will be responsible for providing high-quality patient care in a fast-paced infusion setting.Key ResponsibilitiesAdminister medications and treatments to patients as prescribed by...
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Registered Nurse
1 day ago
Palo Alto, California, United States MFS Talent Full timeAbout the RoleMFS Talent is seeking a highly skilled Registered Nurse to join our team as an Oncology Specialist. In this role, you will be responsible for providing exceptional patient care and support to individuals undergoing cancer treatment.Key ResponsibilitiesPatient Assessment and Care Planning: Conduct thorough assessments of patients to identify...
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Advanced Practice Nurse Specialist
2 weeks ago
Palo Alto, California, United States Lucile Packard Children's Hospital Full timeNursing Team 1.0 FTE, 10 Hour Day Shift At Lucile Packard Children's Hospital, we believe that exceptional care is rooted in compassionate service. Our commitment to merging cutting-edge technology with a family-oriented approach is at the heart of our mission. We seek dedicated individuals who share our vision of healing children and families. Department...
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Travel Nurse RN Oncology Specialist
4 days ago
Palo Alto, California, United States Cross Country Nurses Full timeJob SummaryCross Country Nurses is seeking a skilled Travel Nurse RN Oncology Specialist to provide high-quality patient care in a dynamic and challenging environment.Key ResponsibilitiesAssess patient condition and develop effective care plans to ensure optimal health outcomes.Administer chemotherapy treatments and monitor patient responses.Provide...
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Advanced Practice Nurse Specialist
2 weeks ago
Palo Alto, California, United States Lucile Packard Children's Hospital Full timeNursing Staff 1.0 FTE, 10 Hour Day Shift At Lucile Packard Children's Hospital, we understand that exceptional care is rooted in compassion. Our commitment to combining innovative technologies with a family-centered approach drives our mission to heal humanity, one child and family at a time. Department Overview The Bass Cancer Center for Childhood Cancer...
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Clinical Nurse Specialist
2 weeks ago
Palo Alto, California, United States Houston Methodist Clear Lake Hospital Full timePOSITION OVERVIEWAt Houston Methodist Clear Lake Hospital, the Clinical Nurse Specialist for Wound Care plays a pivotal role in delivering high-quality, integrated patient care for individuals facing complex health challenges across various care environments. This position serves as a vital clinical resource and advisor for both acute and rehabilitative...
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Travel Nurse RN
5 days ago
Palo Alto, California, United States Aureus Medical Group - Nursing Full timeJob Title: Travel Nurse RN - Oncology SpecialistJob Type: Travel NursingSpecialty: OncologyLocation: CaliforniaJob Description:Aureus Medical Group - Nursing is seeking a skilled travel nurse RN to join our team in a dynamic oncology setting. As a travel nurse with Aureus, you will have the opportunity to work with a variety of patients and healthcare...