- LA Care Health Plan (Los Angeles, CA)
- …required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory timelines by ... obtaining clarification on initial responses. (25%) Under the supervision of the Appeals and Grievance Manager , assist with soliciting non-clinical information… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is...assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and cohesive unit with… more
- Elevance Health (Walnut Creek, CA)
- **Behavioral Health Medical Director-Psychiatrist Appeals ** **Location:** California. This role enables associates to work virtually full-time, with the exception of ... clinical operational aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss… more
- Sharp HealthCare (San Diego, CA)
- …**Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager ... Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) - American Case...Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers.Review all cases with readmission… more
- Select Medical (Los Angeles, CA)
- …A Joint Venture with Cedars, UCLA, and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) - 8 hr shifts Registered Nurse (RN) ... at Cal Rehab have a high discharge to home rate. **Benefits of working as a Case Manager with us:** + Excellent Orientation Program + Paid Time Off (PTO) +… more
- Alameda Health System (San Leandro, CA)
- SLH Case Manager RN + San Leandro, CA + San Leandro Hospital + SLH Social Services + Part Time - Day + Care Management + $58.74 - $97.91 per hour + Req ... + Posted:August 12, 2025 **Summary** **JOB SUMMARY** The SLH Case Manager RN is responsible for providing...contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic… more
- Amergis (French Camp, CA)
- …$518.00 $924.00 $3,042.00 **Local Pay $75/hr** - No stipend pay The RN Case Manager is responsible for coordinatingcontinuum of care activities for assigned ... in state practicing + At least one year of Case Management experience preferred + Current CPR if applicable...nurse: We need someone that is current with Denials, Appeals and utilization review . If a candidate had… more
- Cardinal Health (Sacramento, CA)
- …insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed + Resolve patient's questions and any representative ... for the patient's concerns regarding status of their request for assistance + Demonstrate expertise in payer landscapes and insurance processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare,… more
- City and County of San Francisco (San Francisco, CA)
- …the following duties: QUALITY CONTROL, INVESTIGATIONS, OVERPAYMENTS, AND/OR APPEALS SPECIALIST Under general supervision, the Quality Control, Investigations, ... Overpayments or Appeals Specialist performs investigations in support of human service...correspondence with the client + Reviews and analyzes client case records, case information, and other pertinent… more
- LA Care Health Plan (Los Angeles, CA)
- Technical Applications Manager II Job Category: Information Technology Department: IT Solutions Delivery Location: Los Angeles, CA, US, 90017 Position Type: Full ... safety net required to achieve that purpose. Job Summary The Technical Application Manager II reports to the Senior Manager Information Technology IT Solutions… more