Appeals and Grievances Specialist

About the RoleWe are seeking a highly skilled Clinical Appeals and Grievances Specialist to join our team at Blue Shield of California. As a key member of our Appeals and Grievances team, you will play a critical role in ensuring that our members receive fair and timely resolutions to their appeals and grievances.Key ResponsibilitiesAssist with telephone...

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...

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,...

{"Job SummaryWe are seeking a skilled Clinical Appeals Specialist to join our team at Blue Shield of California. In this role, you will be responsible for conducting thorough clinical reviews of member appeals and grievances, ensuring that our members receive the care they need.Key ResponsibilitiesConduct accurate and timely clinical reviews of...

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 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 internal...

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 RoleBlue Shield of California is seeking a skilled Case Management Specialist to join our team. As a Case Management Specialist, you will play a critical role in ensuring our members receive high-quality, cost-effective care.Key ResponsibilitiesDevelop and Implement Care PlansDesign and implement individualized care plans that promote quality,...

About the RoleThe Medical Director, Operations will play a key role in ensuring the delivery of high-quality healthcare services to Blue Shield of California members. This position will be responsible for reviewing and making determinations regarding member and provider requests for service, including prior authorization, concurrent reviews, retrospective...

About the RoleThe Medical Director, Operations will play a key role in ensuring the delivery of high-quality healthcare services to Blue Shield of California members. This position will be responsible for reviewing and making determinations regarding member and provider requests for service, including prior authorization, concurrent reviews, retrospective...

About the RoleBlue Shield of California is seeking a highly skilled Care Management Specialist to join our team. As a Senior Case Manager, you will play a critical role in supporting the mission of our department, which is to provide exceptional care to our patients in the outpatient setting.Key ResponsibilitiesResearch and Design Treatment Plans: Develop...

Job SummaryWe are seeking a highly skilled Senior Care Manager to join our team at Blue Shield of California. As a Senior Care Manager, you will play a critical role in ensuring that our members receive high-quality, cost-effective healthcare services.Key ResponsibilitiesDevelop and Implement Care PlansDesign and implement individualized care plans that...

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...

About the RoleWe are seeking a highly skilled Medical Director 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 ResponsibilitiesDevelop and deploy medical management...

About the Role The Care Management team at Blue Shield of California is seeking a highly skilled and experienced Care Manager to support the mission of the department. As a Care Manager, you will play a critical role in ensuring that services are provided based on standardized procedures, including coordination of care with specialists, community resources,...

About the RoleThe Clinical Leadership Director, Operations will provide strategic clinical leadership within the Blue Shield of California Medical Management department. This role will oversee clinical review activities, including management of physician processes, utilization management, and transactional functions.Key ResponsibilitiesLead clinical review...

About the RoleBlue Shield of California is seeking a highly skilled Care Manager to join our team. As a Care Manager, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.Key ResponsibilitiesDevelop and Implement Care Plans: Research and design treatment/care plans to promote quality of care and cost-effective...

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...