- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department : CSC Appeals & Grievances Location: Los Angeles, ... net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances...in a manner consistent with regulatory requirements from the Department of Managed Health Care, Department of… more
- Sharp HealthCare (San Diego, CA)
- …documents as appropriate in the electronic medical record and provides information to the department head as indicated. + Utilization review and utilization ... **Facility:** Sharp Memorial Hospital **City** San Diego ** Department ** **Job Status** Regular **Shift** Day **FTE** 1...1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager … more
- Alameda Health System (San Leandro, CA)
- SLH Case Manager RN, Full Time, Benefited, Days, 8hours, 1.0fteFeatured Job + San Leandro, CA + San Leandro Hospital + SLH Social Services + Full Time - Day + Care ... + FTE:1 + Posted:July 22, 2025 **Summary** **Job Summary:** The SLH Case Manager RN is responsible for providing comprehensive case management services to clients… more
- City and County of San Francisco (San Francisco, CA)
- …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 ... The Department of Public Health prioritizes equitable and inclusive...the eligible list. Under general supervision, the 2322 Nurse Manager (NICU) supervises the delivery and evaluation of nursing… more
- Sharp HealthCare (San Diego, CA)
- …leadership and direction to the functions within the Medical Management + Department ( Utilization /Cost Management and Quality Management) + Responsible for and ... **Facility:** Health Plan **City** San Diego ** Department ** **Job Status** Regular **Shift** Day **FTE** 1...+ Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager… more
- Sharp HealthCare (La Mesa, CA)
- …as appropriate in Cerner and Allscripts Care Management and provides information to the department head as indicated. + Utilization review and utilization ... **Facility:** Grossmont Hospital **City** La Mesa ** Department ** **Job Status** Per Diem **Shift** Day **FTE**...0 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager … more
- Sharp HealthCare (San Diego, CA)
- …leadership and direction to the functions within the Medical Management Department ( Utilization /Cost Management and Quality Management) + Develops and ... **Facility:** Health Plan **City** San Diego ** Department ** **Job Status** Regular **Shift** Day **FTE** 1...as needed.Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager… more
- Evolent (Sacramento, CA)
- …to the support services review process. Responsible for the quality of utilization review determinations, including appeals . + Provides input into audit ... training classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts… more
- The County of Los Angeles (Los Angeles, CA)
- …an assistant to the manager of a line operation in a County department . Experience at the level of the Los Angeles County's Class of Administrative Assistant Iis ... making recommendations to line managers on matters such as: utilization of personnel; allocation of funds; workload and workload...manager of a line operation in a County department . Experience at the level of the Los Angeles… more
- Highmark Health (Sacramento, CA)
- …and testing processes in partnership with the pharmacy benefits manager . The successful candidate will possess excellent communication, analytical, and ... RESPONSIBILITIES** + Monitor FDA-approvals, drug manufacturer pipelines, assess drug utilization reports, and write drug monographs for Committee review to… more
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