IC
Posted:
June 17, 2026
Location:
United States, United States, United States
Job Description
Our Client, a Healthcare company, is looking for a Medical Review 3 for their Remote/ CA location. Responsibilities:
+ The Commercial Appeals and Grievance RN reviews and processes appeals resulting from a member generated pre-service or post-service concern or complaint.
+ The Commercial Appeals and Grievance RN will report directly to the Nurse Manager and be responsible for reviewing all medical records and documentation concurrently while processing these member-generated appeals.
+ In this role, the RN will perform accurate and timely first level reviews according to company and regulatory standards, utilize National Coverage Determination (NCD) guidelines, Local Coverage Determination (LCD) guidelines, Milliman Care guidelines and other nationally recognized sources such as NCCN and ACOG.
+ The Appeals and Grievance RN will review appeals for benefits, medical necessity, coding accuracy and medical policy compliance.
+ In thi...
+ The Commercial Appeals and Grievance RN reviews and processes appeals resulting from a member generated pre-service or post-service concern or complaint.
+ The Commercial Appeals and Grievance RN will report directly to the Nurse Manager and be responsible for reviewing all medical records and documentation concurrently while processing these member-generated appeals.
+ In this role, the RN will perform accurate and timely first level reviews according to company and regulatory standards, utilize National Coverage Determination (NCD) guidelines, Local Coverage Determination (LCD) guidelines, Milliman Care guidelines and other nationally recognized sources such as NCCN and ACOG.
+ The Appeals and Grievance RN will review appeals for benefits, medical necessity, coding accuracy and medical policy compliance.
+ In thi...
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Job Type:
Full-time
Location:
United States, United States
Posted:
June 17, 2026
Deadline:
June 21, 2026