Posted in Other about 2 hours ago.
Location: Orange, California
Location: Orange, CA
Salary: $40.00 USD Hourly - $43.00 USD Hourly
Description:
Judge Healthcare is seeking a Grievance & Appeals Nurse Specialist in Orange, CA!
Job Summary:
The Grievance and Appeals Nurse Specialist is responsible for managing medical appeals and state hearing reviews across all lines of business, including both expedited and standard requests. This role ensures that appeals and state hearing requests are processed in compliance with regulations, standards, and internal policies.
Key responsibilities include investigating and preparing case narratives and position statements based on clinical information, benefits, and relevant regulations. The specialist will clearly present the facts and positions regarding disputes to the Administrative Law Judge and will create and review resolution letters to ensure they meet clinical and regulatory requirements.
Position Responsibilities:
The Judge Group Inc.
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The Judge Group Inc.
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The Judge Group Inc.
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Siouxland Community Health Center
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Siouxland Community Health Center
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Eurofins Lancaster Laboratories Professional Scientific Services, LLC
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