Grievance & Appeals Nurse Specialist - Orange - Equiliem

    Equiliem
    Equiliem Orange

    2 days ago

    Default job background
    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:

    • 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.

    Requirements:

    • 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.

    Benefits:

    • Medical Insurance
    • Vision & Dental insurance
    • Life Insurance
    • 401K
    • Commuter Benefits
    • Employee Discounts & Rewards
    • Payroll Payment Options

    Salary:

    $120,000 - $150,000 per year, depending on experience.



  • Sunshine Enterprise Inc Orange

    Grievance & Appeals Nurse Specialist · At Sunshine Enterprise USA, we're a community of dedicated professionals committed to excellence and innovation. As a leading force in the business landscape, we take pride in bringing together great people and great organizations by fosteri ...


  • University Of California Irvine Fountain Valley

    Job Title: Neonatal Clinical Nurse Specialist · About Us · UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. We provide tertiary and quaternary care at UCI Medical Center, a 459-bed acute car ...


  • Solventum Irvine

    Job Title: Occupational Health Nurse - Solventum · We are seeking a skilled Occupational Health Nurse to join our team at Solventum. This role will be responsible for partnering with plant site leadership, supervisors, manager, EHS, HR, EAP, and occupational medicine to ensure em ...


  • NuWest Travel Nursing Orange

    Job Title: · NuWest Travel Nursing is seeking a travel nurse ICU - Intensive Care Unit specialist. · Job Details: · Specialty: ICU - Intensive Care Unit · Discipline: RN · Estimated Salary: $120,000 - $180,000 per year · Duration: 13 weeks · Hours per Week: 36 · Shift: 12 hours, ...


  • University of California Berkeley Orange

    Patient Care Specialist · ">The incumbent is responsible for delivering high-quality patient care in a designated neuropsychiatry unit by implementing individualized treatment plans tailored to each patient's unique needs. This role requires strong clinical skills, effective comm ...


  • Nexus HR Services Orange County Full time

    Job Title · PACE Primary Care Provider - Orange County, California · Compensation: · $240,000 - $280,000 per year · About the Job · Nexus HR is seeking a board-certified PACE Primary Care Provider for a reputable client in Orange County, California. The ideal candidate must be en ...


  • CHOC Children's Specialists Orange

    Summary: CHOC Specialists seeks a Board Certified/Eligible Pediatric Endocrinologist to join a dynamic, full-service team, providing expert care for infants, children, adolescents, and young adults. · About CHOC Specialists: A private pediatric subspecialty group with 26 pediatri ...


  • CalOptima Orange

    **Medical Case Manager Job Description** · We are seeking a highly motivated and experienced Medical Case Manager to provide ongoing case management services for our members. The Medical Case Manager will facilitate communication and coordination among all participants of the hea ...

  • Surgery Care Affiliates

    Lead Scheduler

    17 hours ago


    Surgery Care Affiliates Orange

    Overview · Today, SCA Health is a community of 11,000 teammates who care for over 1 million patients annually and support physician specialists in various aspects of patient care. Our team creates value in specialty care by aligning physicians, health plans, and health systems ar ...


  • Della Infotech Orange

    Blood Bank Specialist Job Description · We are seeking a highly skilled Blood Bank Specialist to join our team at {company}. This is a unique opportunity to work in a dynamic environment and contribute to the success of our organization. · Key Responsibilities: · Perform complex ...


  • Senior Doc Orange Full time

    Job Title: · Geriatrician/Mobile Doctor, Regional Medical Director · Summary: · We are seeking a compassionate Geriatrician to join our Mobile Primary Care, Geriatric House Call Group in Northern and Central Orange County, CA. · Key Responsibilities: · Conduct comprehensive medic ...


  • CHOC Children's Specialists Orange

    Job Title: Pediatric Pulmonary Physician · Location: Orange County, California · CHOC Specialists, a private pediatric subspecialty group, is seeking a full-time Board Certified/Eligible Pediatric Pulmonologist. The ideal candidate will have additional training and Board certific ...


  • SCA Health Orange

    Our team of 11,000 cares for 1 million patients yearly, supporting physician specialists in patient care. Together, we align physicians, health plans, and health systems to deliver high-quality outcomes, a better experience, and lower total care costs. · We participate in an inte ...

  • Kaiser Permanente

    Charge Nurse

    2 days ago


    Kaiser Permanente Orange

    Job Title: · Labor and Delivery Charge Nurse (RN) · Job Description & Requirements · Specialty: Labor and Delivery · Discipline: RN · Duration: Ongoing · 20 hours per week · Shift: 8 hours, nights · Employment Type: Staff · Job Summary: · The Labor and Delivery Charge Nurse (RN) ...


  • CHOC Children's Specialists Orange

    Pediatric Gastroenterologist · ">CHOC Specialists is a leading private pediatric subspecialty group with 26 pediatric subspecialties, practicing at Children's Hospital of Orange County (CHOC). CHOC is exclusively committed to the health and well-being of children through clinical ...


  • EMERGENCY MEDICINE SPECIALISTS OF ORANGE COUNTY Orange

    Job Description · The Emergency Medicine Specialists of Orange County (EMSOC), one of the largest independent groups in California, is seeking skilled Nurse Practitioners (NPs) and Physician Assistants (PAs) who demonstrate excellence in patient care. · Key Responsibilities: · Ob ...


  • HealthCHEC Orange

    Job Title: Advanced Practice Clinician · About SCAN · SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. We are known throughout the healthcare industry and nationally as a leading expert in senior ...


  • Pacific Neuropsychiatric Specialists Inc Orange Full time

    Job Title · Patient Care Specialist - Physician AssistantWe are seeking a highly motivated and compassionate Physician Assistant to join our outpatient private mental health group practice. Our team of Psychiatrists, Nurse Practitioners, Physician Assistants, and Therapists work ...


  • VGroup Inc Orange Full time

    Job Description for Medical Case Manager · We are seeking a highly motivated and experienced Medical Case Manager to join our team at CalOptima Health. The successful candidate will have excellent communication and coordination skills, with the ability to work effectively with me ...


  • Registry Ally, Inc. Orange, CA

    Job Title: On Site Clinical Documentation Manager · Job Details:Location: Orange, CA · Job Type: Full Time Permanent Position · Salary: Highly Competitive · Benefits: Excellent Benefits · Job Summary · The Clinical Documentation Manager is responsible for leading and managing the ...


  • New York Cancer & Blood Specialists Orange

    Registered Nurse - Float · We are seeking a skilled and compassionate Registered Nurse to join our team in the Hudson Valley Region. As a Float RN, you will have the opportunity to work at various locations across the region, including Poughkeepsie, Middletown, Newburgh, Fishkill ...

Jobs
>
Orange
>
Grievance & appeals nurse specialist