Healthcare Appeals Specialist

{"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...

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...

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...

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...

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 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...

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 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 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...

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 Senior Utilization Management Nurse to join our team at Blue Shield of California. As a key member of our Utilization Management team, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.Key ResponsibilitiesPerform prospective utilization reviews and first-level...

Job SummaryNationwide Therapy Group is seeking a skilled Emergency Department Nurse Specialist to join their team as a Traveling Registered Nurse.Key ResponsibilitiesProvide high-quality patient care in the Emergency Department settingCollaborate with healthcare professionals to ensure seamless patient careDevelop and implement effective nursing plans to...

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 Title: Travel Nurse RN - Long Term Acute Care SpecialistJob Summary: Host Healthcare is seeking a skilled Travel Nurse RN - Long Term Acute Care Specialist to join our team. As a Travel Nurse RN - Long Term Acute Care Specialist, you will provide high-quality patient care in a long-term acute care setting.Responsibilities:Provide direct patient care to...

About Dignity HealthDignity Health is a healthcare organization that prioritizes delivering excellent care with compassion to those in need. Our mission is to positively impact the health and well-being of entire communities.Job SummaryWe are seeking a skilled Patient Services Representative to join our team. As a Patient Services Representative, you will...

Job Summary:We are seeking a highly skilled and compassionate Customer Service Representative to join our team at Niahealthcare. As a key member of our customer service team, you will be responsible for providing exceptional service to our members and providers, ensuring that their needs are met and exceeded.Key Responsibilities:Answer incoming calls related...

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...

Job Title: End User Services (EUS) Technical Support SpecialistCommonSpirit Health, a leading healthcare organization, is seeking a skilled professional to fill the role of End User Services (EUS) Technical Support Specialist. As a member of our EUS team, you will play a critical role in ensuring the smooth operation of our desktop hardware and software...