- Humana (Sacramento, CA)
- …market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for several months ... after training, until positions become available for specific markets. May participate on project teams or organizational committees. Work at Home Guidance To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet… more
- CVS Health (Sacramento, CA)
- …and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents expectations are met or ... exceeded. + Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member… more
- Sharp HealthCare (San Diego, CA)
- …to Revenue Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers.Review all cases with readmission within 30 days; ... report findings in the EMR and in accordance with the departmental policy.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation with Physician Advisor or Medical… more
- UCLA Health (Santa Monica, CA)
- …+ Ability to interpret medical information required to perform second level appeals . + Ability to retrieve, interpret, and utilize departmental and third-party ... insurance policies and procedures effectively. + Ability to speak with persons from various social, cultural, economic and educations backgrounds to obtain information and explain authorization process. + Skill in speaking clearly and distinctly using correct… more
- Elevance Health (Los Angeles, CA)
- …a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any ... embassy located in or outside of the US. + Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. + For Health Solutions and Carelon organizations (including behavioral health)… more
- City and County of San Francisco (San Francisco, CA)
- …The terms of this announcement may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department of Human Resources, 1 S ... Van Ness Avenue, 4th Floor, San Francisco, CA 94103-5413 by close of business on the 5th business day following the issuance date of this examination announcement. Information concerning other Civil Service Commission Rules involving announcements,… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …complaints of employees and referring others, such as formal grievances and appeals to the supervisor or an appropriate management official. Prepares the clinical ... environment, which may include preparing medical and telecommunications equipment to be used for clinical examination and treatment. Serves as an imager and data manager for store and forward telehealth (SFT) clinical encounters including tasks such as… more
- Elevance Health (Walnut Creek, CA)
- …to work with facilities and providers for care-coordination. + May also manage appeals for services denied. + Serves as mentor to lower leveled managers and ... as subject matter expert for other areas of the company and within the department. + Manages multiple functions requiring unique sets of knowledge or has significant fiscal accountability. + Develops and manages annual operating budget. + Hires, trains,… more
- City and County of San Francisco (San Francisco, CA)
- …The terms of this announcement may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department of Human Resources, 1 S ... Van Ness Avenue, 4th Floor, San Francisco, CA 94103-5413 by close of business on the 5th business day following the issuance date of this examination announcement. Information concerning other Civil Service Commission Rules involving announcements,… more
- Evolent (Sacramento, CA)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as a… more