Description

As the Appeals & Grievances Nurse, you will play a key role in managing and resolving New Century Health Plan member appeals and grievances. You will:

Ensuring timely, accurate, and thorough review of member and provider complaints, working closely with clinical and administrative teams. Assessing cases to determine the appropriateness of medical care and services rendered in relation to Medicare guidelines, compliance requirements, and internal policies. Identifying and investigating Potential Quality Issues (PQIs) to ensure continuous improvement in care delivery. Complete other duties as assigned.  Salary Range: $61.79-$79.91/hourly