Jobs near Los Angeles: 16,162
RS
Relevance Score ranked on: APPEALS
Nurse Appeals CA
LOS ANGELES, 303 S UNION AVE
Conducts investigations and reviews of member and provider medical necessity appeals. Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity. Extrapolates and summarizes medical information for medical director, consultants and other external review....
Search Terms: Appeals, Nurse, Medical Director, Skills, Healthcare
86.7
0mi
Updated: May 01
Nurse Appeals CA
LOS ANGELES, 303 S UNION AVE
Conducts investigations and reviews of member and provider medical necessity appeals. Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity. Extrapolates and summarizes medical information for medical director, consultants and other external review....
Search Terms: Appeals, Nurse, Medical Director, Skills, Healthcare
86.7
0mi
Updated: May 01
Grievance and Appeals Coordinator (CA residents)
Los Angeles
Speaki[ "\n\tspeaking with healthcare providers and members\n\tutilizing different material and navigating through systems\n\tcommunicating with internal and external parties\n\tformulating responses in writing to members\n\n" ][ "Experience. Experienced 1 year. Education. High School" ]
Search Terms: Coordinator, Appeals, Administrative, Staffing
83.3
0mi
Updated: April 26
Supervisor, Appeals and Grievances Clinical Operations RN
Los Angeles
The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the day-to-day clinical operations of the A&G department, and monitoring the A&G RN staff responsibilities and activities. This includes, but is not limited to, ensuring proper staffing and coverage; mo...
Search Terms: Operations, Clinical, RN, Supervisor, Appeals
81.3
5.7mi
Updated: March 28
Nurse Appeals CA
CERRITOS, 12900 PARK PLAZA DR
Conducts investigations and reviews of member and provider medical necessity appeals. Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity. Extrapolates and summarizes medical information for medical director, consultants and other external review....
Search Terms: Appeals, Nurse, Medical Director, Skills, Healthcare
80.9
13mi
Updated: May 01
Nurse Appeals CA
CERRITOS, 12900 PARK PLAZA DR
Conducts investigations and reviews of member and provider medical necessity appeals. Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity. Extrapolates and summarizes medical information for medical director, consultants and other external review....
Search Terms: Appeals, Nurse, Medical Director, Skills, Healthcare
80.9
13mi
Updated: May 01
Appeals and Grievances Medical Director - Otolaryngology (ENT) Specialty Required - Remote
Cypress
Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical c...
Search Terms: Medical Director, Director, Appeals, Medical, Healthcare
79.9
16mi
Updated: April 26
Appeals and Grievances Medical Director - Otolaryngology (ENT) Specialty Required - Remote
Cypress
Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical c...
Search Terms: Medical Director, Director, Appeals, Medical, Healthcare
79.9
16mi
Updated: April 26
Senior Pharm PA/Appeals Technician
Cypress
Become knowledgeable with our process to best support our members Expected to meet departments production, quality, and success rate standards Work independently and as a team player to achieve individual and departmental goals Make outbound phones to collect clinical information for Medicare Part D ...
Search Terms: Technician, Pharmacy Technician, Appeals, Senior, Health
79.7
16mi
Updated: May 08
Appeals and Grievances Medical Director - PM&R Physician - Remote
Cypress
Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical c...
Search Terms: Medical Director, Director, Appeals, Medical, Physician
79.7
16mi
Updated: April 23
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