Senior RN, Medical Appeals & Grievances - Hybrid
Blue Shield of CA
Blue Shield of California's Medi-Cal Member Appeals and Grievances team seeks an RN Senior to conduct clinical reviews of member appeals arising from preservice, post-service, or claim denial. The role reports to the Appeals and Grievances Manager and focuses on timely, evidence-based decisions. You will work with Medical Directors and coordinators to identify PQI, QOS, and QOC cases, ensuring members' clinical needs are met within 30 days or within 72 hours for expedited requests, while #J-18808-Ljbffr Blue Shield of CA
Vacancy posted 3 days ago
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