Grievance And Appeals

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your RoleThe Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

Your Role The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical...

About this RoleThe Grievance and Appeals Nurse serves as a key liaison between the company, IPAs, hospitals, and other stakeholders to ensure that grievances and appeals are processed efficiently and in accordance with regulatory guidelines. This role involves coordinating care with members, PCPs, and IPAs to provide continuous quality care and assist in the...

Compliance Auditor III Rancho Cucamonga, California What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! The Compliance Auditor III is responsible to lead and conduct key activities of the IEHP Compliance Audit...

What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Compliance Auditor III is responsible to lead and conduct key activities of the IEHP Compliance Audit Program. The Compliance Audit III will oversee...

What you can expect!Ready to make your application Please do read through the description at least once before clicking on Apply.Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Compliance Auditor III is responsible to lead...

What you can expect!Ready to make your application Please do read through the description at least once before clicking on Apply.Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Compliance Auditor III is responsible to lead...

About This RoleWe are seeking a highly skilled Senior Care Manager to join our Care Management team at Blue Shield of California. As a key member of our team, you will play a pivotal role in coordinating and managing patient care services in outpatient settings.Key ResponsibilitiesDesign and implement individualized care plans that ensure continuity of care...

Job SummaryWe are seeking a highly skilled Nurse Case Manager to join our team in the outpatient setting. As a Senior Care Manager, you will play a pivotal role in coordinating and managing patient care services, ensuring continuity of care and compliance with clinical guidelines.About the RoleThis position requires a strong clinical background, excellent...

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! The Compliance Auditor III is responsible for leading and conducting key activities of the IEHP Compliance Audit Program. The Compliance Auditor III will...

Job Description:We are seeking a Senior Behavioral Health Case Manager to join our team at Blue Shield of California. As a key member of our care management team, you will play a vital role in providing high-quality care to our members.About the Role:This is a permanent position that requires a Bachelor's degree in Nursing and current RN licensure. The ideal...

Senior Nurse Care Coordinator Role OverviewWe are seeking a highly skilled and experienced Senior Nurse Care Coordinator to join our team at Blue Shield of California.About the Role:Coordinate and manage patient care services in outpatient settings, designing and implementing individualized care plans while ensuring continuity of care and compliance with...

At Blue Shield of California, we are dedicated to providing exceptional care management services to our members. We are seeking a highly skilled and compassionate Healthcare Specialist - Care Management to join our team.About the RoleThis role will be responsible for ensuring that our members receive high-quality, cost-effective healthcare services. You will...

Job SummaryWe are seeking a highly skilled and experienced Healthcare Manager to join our team at Blue Shield of California. This role involves providing integrated case management and disease management activities, demonstrating clinical judgment and independent analysis, and collaborating with members and healthcare professionals.About the RoleThe...

Your Role The Utilization Management team reviews the inpatient stays for our members under the guidelines for nationally recognized levels of care. The Utilization Management Nurse, Senior will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and review clinical information provided by the...

Your Role The Utilization Management team reviews the inpatient stays for our members under the guidelines for nationally recognized levels of care. The Utilization Management Nurse, Senior will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and review clinical information provided by the...