Executives

Nurse Level 1 2A Job Group Healthcare Family Name Complaints Grievance and Appeals Job Title Nurse Level 1 2A Functional Title Coding Reconsideration - Nurse Consultant Exemption Status Non-Exempt Family Summary Mission Provide comprehensive clinical review of complaints and appeals filed by providers with the use of appropriate resources and guidelines to ensure cost effective delivery of health service Position Summary Mission Supports identification and review of appropriate case types in compliance with the clinical guidelines Promotes supports quality effectiveness of Healthcare Services Fundamental Components Physical Requirements include but are not limited to Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations Considers all documented system information as well as any additional records data presented to develop a determination or recommendation Condenses complex information into a clear a...