The job below is no longer available.
You might also like
in Monterey, CA
$2,800Verified per week Genie Healthcare • 4d agoUrgently hiring 12.2 mi Use left and right arrow keys to navigate- $2,800
Verified per week Genie Healthcare • 2d agoUrgently hiring 12.2 mi Use left and right arrow keys to navigate 
$34est. per hour Cypress Healthcare Partners • 12h ago12.2 mi Use left and right arrow keys to navigate- $75
est. per hour Cypress Healthcare Partners • 12h ago12.2 mi Use left and right arrow keys to navigate - $34
est. per hour Alsana • 2h ago5.2 mi Use left and right arrow keys to navigate
Appeals & Grievances Nurse (RN or LVN) Job
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Monterey, CA Monterey, California |
About this job
Appeals & Grievances Nurse (RN or LVN) needed for a contract to Hire opportunity with Yoh's client located in Monterey Park, CA.
Top Skills Should You Possess:
- Registered Nurse or Licensed Vocational Nurse in State of CA (Active and in Good Standing)
- Three-Five (3- 5) years of Utilization Management / Appeals and Grievance Experience in a Managed Care Setting
- Experience reviewing medical records to establish level of clinical care
What You'll Be Doing:
- Responsible for evaluating clinical appeals and grievances received from Providers of members
- Review of pre-service and post-service appeals
- Review of inpatient provider appeals, legal, and second-level appeal cases.
What You Need to Bring to the Table:
- Registered Nurse or Licensed Vocational Nurse in State of CA (Active and in Good Standing)
- Three-Five (3- 5) years of Utilization Management / Appeals and Grievance Experience in a Managed Care Setting
- Bilingual English/Spanish preferred
- Hospital inpatient process knowledge
- Experience reviewing medical records to establish level of clinical care
- Extensive knowledge of AB1455 regulations thorough knowledge of provider billing, CPT codes, appeals process and regulations of Medicare, Medi-Cal, DHS, MRMIB, DMHC and NCQA.
- Computer proficiency with MS Office Suite, including Word, Excel and Access
- Monday - Friday (days) 8:00 am - 5:00 pm (or) 9:00 am - 6:00 pm
Opportunity is Calling, Apply Now!
Recruiter: Christine Torres
Phone: 818.587.4463
Email: Christine.torres@yoh.com
Yoh makes finding and applying for jobs simple. Partner with Yoh to find the right opportunities across multiple industries in the US and UK. Find out more !
Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Click here to contact us if you are an individual with a disability and require accommodation in the application process.
J2W: HC
MONJOB
CB1
J2WSWHLTH
Ref: 1061679
SFSF: HC
Your Privacy Choices