A company is looking for an Appeals and Grievances Clinical Specialist - RN or LPN, 100% Remote.Key ResponsibilitiesManage clinical case development and resolution for member and provider complaintsPrepare cases for Medical Director Review and external appeals processesEnsure compliance with Federal and State regulations while managing caseloadsRequired QualificationsMust be an RN, LPN, or Dental HygienistBachelor's degree preferredExperience in clinical practice, appeals & grievances, or utilization managementUnderstanding of Utilization Review Guidelines and related regulationsAbility to work with care management systems and multiple computer applications
Clinical Appeals Specialist RN
A company is looking for a Clinical Appeals Specialist RN (Remote). ...
LPN | Licensed Practical Nurse | Great Community & Benefits$
They do not discriminate on the basis of race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected u...
LPN Clinical Program Specialist
A company is looking for an LPN - RX Clinical Program Professional. ...
Registered Nurse-RN or Licensed Practical Nurse-LPN Supervisor
Registered Nurse-RN or Licensed Practical Nurse-LPN Supervisor. Registered Nurse-RN or Licensed Practical Nurse-LPN Supervisor. Other duties as assigned by Assistant Director of Nursing, Director of Nursing or Administrator. Ensure staff are performing all duties in accordance with local, state, and...
Appeals and Grievance Specialist
A company is looking for an Appeals and Grievance Specialist responsible for managing the resolution process of medical and pharmacy member appeals and grievances. ...
Unit Manager RN or LPN
Assist the Director of Nursing (DON) in overall operation of the department in accordance with company policies, and standards of nursing practices and government regulations, so as to provide the highest quality of care. Strong attention to detail and accuracy, excellent organizational skills with ...
Specialist I, Clinical Applications (NY or NJ)
Our agile, resourceful team is committed to realizing critical breakthroughs in laboratory diagnostics, information technology, workflow analysis and life sciences for the clinical laboratory. The Clinical Applications Specialist (CAS) is part of a multidisciplinary team that supports the equipment ...
RN, REGISTERED NURSE, 3-11pm or 11-7am SHIFT, $5,000 SIGN ON BONUS, DAILY PAY
Such supervision must be in accordance with current federal, state, and local standards, guidelines, and regulations that govern our Center, and as may be required by the Director of Nursing Services or Nurse Supervisor to ensure that the highest degree of quality care is maintained at all times. To...
Nurse Unit Manager (RN/LPN)
This position will work alongside a phenomenal Director of Nursing (DON) in leading the clinical team to success and providing outstanding care to our residents. As the Nurse Unit Manager, you have the ability to positively impact the lives and overall health of the residents by overseeing the day t...
Clinical Liaison . LPN/RN With Vitability Health of New Jersey
As a Healthcare Liaison, this role combines clinical expertise with an in-depth understanding of patient needs post-discharge, aiming to facilitate smooth transitions and foster collaborative relationships with healthcare facility partners. Valid LPN or RN license in New Jersey, with a minimum of 3 ...