BSC

BSC

Appeals and Grievances - RN, Consultant (MediCare)

Rancho Cordova, CA, United States

Sponsorship not specifiedDetected 6 days ago
Inventory ManagementLeadership

About the role

  • The Medicare Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post service or claim denial.
  • Reviews will also be performed for medical necessity and to meet the criteria for the coding billed.
  • The ideal candidate will have previous leadership experience, hold an active CA license from Board of Registered Nurses and higher-level certifications are highly desirable.

Responsibilities

  • The Medicare Appeals and Grievances RN Lead will report to the Appeals and Grievances Manger.
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