- Investigate and prepare case narratives and statements of position based on clinical information, benefits, and applicable regulations.
- Articulate facts and position regarding disputes to Administrative Law Judges.
- Create and review resolution letters for appropriateness of clinical criteria and regulatory requirements.
- Participate in departmental meetings, trainings, and audits as requested.
- High School diploma required.
- 5 years of healthcare/managed care experience required.
- Active Registered Nurse (RN) license to practice in the state of California preferred.
- Medical Insurance
- Vision & Dental insurance
- Life Insurance
- 401K
- Commuter Benefits
- Employee Discounts & Rewards
- Payroll Payment Options
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Grievance & Appeals Nurse Specialist - Temp
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Grievance & Appeals Nurse Specialist - Orange - Equiliem
Description
Job Title: Grievance & Appeals Nurse Specialist
At {company}, we are seeking a highly motivated and experienced Grievance & Appeals Nurse Specialist to join our team. This role is responsible for managing medical appeals and state hearing reviews, ensuring compliance with regulations and policies.
Key Responsibilities:
Requirements:
Benefits:
Salary:
$120,000 - $150,000 per year, depending on experience.
-
Grievance & Appeals Nurse Specialist - Temp
Sunshine Enterprise Inc- Orange
-
NICU Clinical Nurse Specialist
University Of California Irvine- Fountain Valley
-
Occupational Health Nurse Specialist
Solventum- Irvine
-
Travel Nurse RN
NuWest Travel Nursing- Orange
-
PD Psychiatric Technician
University of California Berkeley- Orange
-
PACE Primary Care Provider
Full time Nexus HR Services- Orange County
-
Endocrinology - Physician
CHOC Children's Specialists- Orange
-
Medical Case Manager
CalOptima- Orange
-
Lead Scheduler
Surgery Care Affiliates- Orange
-
Laboratory - Clinical Lab Scientist
Della Infotech- Orange
-
Primary Care Physician- Geriatrician
Full time Senior Doc- Orange
-
Pulmonology - Physician
CHOC Children's Specialists- Orange
-
Scheduler - LaVeta Surgical Center
SCA Health- Orange
-
Charge Nurse
Kaiser Permanente- Orange
-
Gastroenterology - Physician
CHOC Children's Specialists- Orange
-
Physician Assistant
EMERGENCY MEDICINE SPECIALISTS OF ORANGE COUNTY- Orange
-
Advanced Practice Clinician, Integrated Care Delivery
HealthCHEC- Orange
-
Physician Assistant
Full time Pacific Neuropsychiatric Specialists Inc- Orange
-
Medical Case Manager
Full time VGroup Inc- Orange
-
clinical documentation manager
Registry Ally, Inc.- Orange, CA
-
Registered Nurse
New York Cancer & Blood Specialists- Orange