Appeals & Grievances Nurse in Los Angeles, CA for UCLA

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Social Worker (MSW) - PRN

North Kansas City Hospital

North Kansas City, Missouri

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Physician Assistant or Nurse Practitioner - Hospitalist (nights)

St. Luke’s University Health Network

Easton, Pennsylvania

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Social Worker (MSW)

North Kansas City Hospital

North Kansas City, Missouri

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Complex Case Manager

Harris Health System

Houston, Texas

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RN Case Manager Team Lead

University of Maryland Medical System

Baltimore, Maryland

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Registered Nurse - Care Coordinator - 8 Hour Days

Cedars Sinai

California

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Registered Nurse Care Manager - Case Management

Penn State Health

Enola, Pennsylvania

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Shock Trauma Center: Acute Care Nurse Practitioner (NP) or Physician Assistant (PA)

University of Maryland Medical System

Baltimore, Maryland

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Social Worker Case Manager Days Contract Travel StaffFlex $46.65/hr Tampa

AdventHealth

Tampa, Florida

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RN LEAD CASE MANAGER - CASE MANAGEMENT

Beebe Healthcare

Lewes, Delaware

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CLINICAL CASE MANAGER - STROGER HOSPITAL - INPATIENT CARE COORDINATION

Cook County Health

Chicago, Illinois

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Assistant Senior Services Social Worker (Full Time)

Benefis Health System

Great Falls, Montana

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Social Worker II

University of Maryland Medical System

Baltimore, Maryland

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Registered Nurse RN After Hours RN Hospice

AdventHealth

Altamonte Springs, Florida

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Licensed Practical Nurse LPN Home Health

AdventHealth

Lees Summit, Missouri

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Nurse Manager - Medical Oncology

University of Maryland Medical System

Baltimore, Maryland

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RN Case Manager Full Time

Kindred Hospitals

Las Vegas, Nevada

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RN Case Manager- Part Time Weekdays

Kindred Hospitals

West Covina, California

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Care Manager PRN - Case Management

CHRISTUS Health

Tyler, Texas

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Risk Management Analyst

University of Pennsylvania and Penn Medicine

Philadelphia, Pennsylvania

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Psychiatric Nurse Practitioner- Child/Adolescent Psychiatry

University of Maryland Medical System

Baltimore, Maryland

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Care Manager PRN-Case Management-PRN

CHRISTUS Health

Alexandria, Louisiana

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Nursing Care Assistant (CNA) - Inpatient Medical Oncology - Night Shift

Duke University Health System

Raleigh, North Carolina

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Senior Clinical Documentation Specialist (RN required) (CCDS or CDIP cert preferred)

Vanderbilt Health

Nashville, Tennessee

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RN Case Manager Days Contract Travel StaffFlex $46.65/hr Tampa

AdventHealth

Tampa, Florida

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Appeals & Grievances Nurse

DescriptionAs the Appeals & Grievances Nurse, you will play a key role in managing and resolving New Century Health Plan member appeals and grievances. You will: Ensuring timely, accurate, and thorough review of member and provider complaints, working closely with clinical and administrative teams.Assessing cases to determine the appropriateness of medical care and services rendered in relation to Medicare guidelines, compliance requirements, and internal policies.Identifying and investigating Potential Quality Issues (PQIs) to ensure continuous improvement in care delivery.Complete other duties as assigned. Salary Range: $61.79-$79.91/hourly

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