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Continuum Advantage

60 Continuum Advantage Full Time Jobs Hiring Near You

KVC Missouri

Receptionist- Full Time

Webster Groves, MO · On-site

$14.75 - $19.50/hr

... continuum of care allow children and families to access the appropriate level of treatment ... In fact, we're so proud of our culture that we see it as our top competitive advantage in the ...

MASC Medical

Primary Care Physician

Bradenton, FL · On-site

$190 - $230/hr

Primary Care Physician Bradenton, FL We are seeking a full-time Primary Care Physician to work in ... Must have experience with Medicare Advantage plans/patients. And experience with MRA (quality ...

Banyan

Cook -Full time

Lake Worth, FL · On-site

$12.50 - $16.75/hr

Take advantage of employee training, development, and advancement opportunities. Key ... continuum of services with the esteemed Joint Commission Accreditation (Gold Seal of Approval)

Main Line Health

Care Coordinator RN

Paoli, PA

... the health care continuum, to identify opportunities to continually improve patient care ... Schedule: Full-time * Shift: Day Job * Pay Range: $79,372.80 - $122,969.60 * Job Grade: 113

Main Line Health

Care Coordinator RN

Bryn Mawr, PA · On-site

... the health care continuum, to identify opportunities to continually improve patient care ... Regular Schedule: Full-time Shift: Day Job Pay Range: $79,372.80 - $122,969.60 Job Grade: 113

Main Line Health

Care Coordinator RN

Paoli, PA · On-site

... the health care continuum, to identify opportunities to continually improve patient care ... Regular Schedule: Full-time Shift: Day Job Pay Range: $79,372.80 - $122,969.60 Job Grade: 113

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Infographic showing various Full Time job openings at Continuum Advantage in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Physical job distribution.

Appeals & Grievances Nurse

Western Health Advantage

Sacramento, CA • On-site

Full-time

Re-posted yesterday

Job description

Appeals & Grievances Nurse (RN)Western Health Advantage

Location: Sacramento, CA (Hybrid)
Job Type: Full-Time, Exempt
Salary: $95,000–$115,000 annually
Travel: Occasional travel required
"Purpose that inspires. Impact that improves lives. Join us in building healthier communities." 
Western Health Advantage

Join Our Team

Western Health Advantage (WHA) is seeking an experienced Appeals & Grievances Nurse (RN) to join our Utilization Management team. This role is ideal for a registered nurse with managed care experience who is passionate about ensuring members receive timely, clinically sound, and compliant reviews of appeals and grievances.

Reporting to the Utilization Operations Director, you will collaborate with Medical Directors, Clinical Pharmacists, Appeals & Grievances staff, and contracted provider groups to evaluate complex cases, ensure regulatory compliance, and support exceptional member outcomes.

What You'll Do

As the Appeals & Grievances Nurse, you will:

  • Review medical necessity appeals and grievances requiring clinical evaluation.
  • Research, analyze, and prepare complex appeal cases involving new technology, experimental treatments, transplants, and other specialized services.
  • Determine clinical urgency and provide guidance to the Appeals & Grievances team.
  • Prepare clinical summaries and recommendations for Medical Director review and Appeal Review Meetings.
  • Draft clinical resolution letters for upheld medical necessity determinations.
  • Partner with contracted Medical Groups, hospitals, and providers to coordinate member care and facilitate smooth transitions across the continuum of care.
  • Collaborate with internal departments including Quality Management, Care Management, Member Services, Sales, Marketing, and Wellness on clinical initiatives and special projects.
  • Assist with referrals to Case Management, Disease Management, and Behavioral Health services.
  • Provide care coordination and support for members receiving transgender surgery services.
  • Maintain and update utilization management reference materials, including prior authorization and DME benefit resources.
  • Support regulatory readiness by participating in DMHC, CMS, and NCQA audits, accreditation activities, RFP responses, and Independent Medical Review submissions.
  • Participate in conference calls with regulatory agencies and provide clinical expertise on appeals and grievance cases.
  • Promote compliance with regulatory requirements while ensuring timely, accurate, and member-focused case resolutions.
What You'll BringRequired Qualifications
  • Bachelor's degree in Nursing (BSN).
  • Active and unrestricted California Registered Nurse (RN) license.
  • 3 years’ experience in utilization/case management, discharge planning and/or appeals & grievances in a managed care environment, with increased responsibilities.
  • Strong clinical assessment, critical thinking, and analytical skills.
  • Excellent written and verbal communication skills.
  • Intermediate Microsoft Office skills, including Excel and Word.
  • Certification in Utilization Management (CPHM, CMCN, or equivalent), Quality Management, or Certified Case Manager (CCM).
  • Knowledge of California Department of Managed Health Care (DMHC) regulations.
  • Familiarity with CMS Medicare regulations.
  • Experience supporting NCQA accreditation activities.
  • Experience preparing regulatory responses, audits, or quality improvement initiatives.
Why Join Western Health Advantage?

At WHA, you'll have the opportunity to make a meaningful impact on the quality and accessibility of healthcare for our members. You'll collaborate with experienced clinical leaders in a supportive, mission-driven environment that values clinical excellence, regulatory compliance, and continuous improvement.

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