Purpose: The Lead Nurse works under the direction of the Manager of Clinical Appeals. The Lead Nurse will perform..., and execution of department and organizational goals. The Lead Nurse will maintain regular job duties as a Clinical Appeals Nurse...
Appeals and Grievance (A&G) clinical unit. This position is responsible for the quality review of complex and/or escalated... clinical A&G cases for all line of business (LOB). The Lead will assist in identifying areas of improvement in increasing...
Pay range: : $43 - $65/hr Kinetic Personnel Group is currently recruiting a Grievance and Appeals Nurse Specialist... public agency is renowned for its work in the community and being a great place to work. The Grievance and Appeals Nurse...
Registered Nurse license or foreign medical graduate Req Certified Coding Specialist - CCS (AHIMA) Req Certified Clinical...The Clinical Documentation Improvement (CDI) Supervisor will have an integral part of the departmental leadership team...
* Risk Management Strategy & Program Development f. Design and lead an enterprise-wide clinical risk management program... and implementation of the health plan’s clinical risk management program and plan. This role is accountable for identifying, assessing...
Senior Manager oversees clinical operations teams responsible for medical necessity reviews, clinical grievances and appeals.... Duties Oversees end-to-end clinical case handling, including clinical grievances, clinical appeals, medical necessity...
, and utilization outcomes. Provides oversight and monitoring of the medical claims review and appeals to ensure timely accurate... with other departments within Partnership to develop and implement improvements that will lead to improved performance or enhanced workflow...
activities. Provides oversight and monitoring of the medical claims review, appeals, and grievances within CC to ensure timely... and implement improvements that will lead to improved performance or enhanced workflow of staff. Participates in the planning...