- LA Care Health Plan (Los Angeles, CA)
- …Preferred Certified Case Manager (CCM) Accredited Case Manager (ACM) Certification Case Management Nurse - Board Certified (CMGT-BC) ... needs and requiring the highest clinical skills and judgement. Management of the caseload assigned by Manager ...additional service needs according to specific program guidelines. Uses claims processing and care management software to… more
- Sutter Health (Oakland, CA)
- …**CERTIFICATION & LICENSURE** + RN-Registered Nurse of California Required + Certified Case Manager (CCM) Preferred. **EXPERIENCE** + Minimum of 2 years ... This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure...A broad knowledge base of health care delivery and case management within a managed care environment.… more
- AECOM (Los Angeles, CA)
- …us. **Job Description** **AECOM** has an exciting opportunity for an Environmental Project Manager with a Professional Engineering License to join our Long Beach, CA ... consulting industry, who is also a seasoned Environmental Project Manager and who would like to grow their career...+ Directs staff to operate and minimize exposure to claims . + Supervises and directs Project Managers with multiple… more
- Ventura County (Ventura, CA)
- …Senior Medical Management Nurse is responsible for performing utilization review, case management , and quality improvement functions to ensure that members ... eligibility benefits, contracts and industry standards/guidelines; + Performs telephonic care/ case management within the scope of licensure...Managed Health Care Plan. + Experience working as a case manager in a health plan … more
- ZOLL Medical Corporation (Modesto, CA)
- …patients suffering from serious cardiopulmonary and respiratory conditions.ZOLL Cardiac Management Solutions offers a unique portfolio of novel technologies designed ... patients at risk of sudden cardiac death. + HFMS (https://cardiacdiagnostics.zoll.com/products/heart-failure-arrhythmia- management -system/) (Heart Failure Management system) is a… more
- Travelers Insurance Company (Sacramento, CA)
- …Practices. Provide quality claim handling and superior customer service on assigned claims , while engaging in indemnity & expense management . Promptly manage ... reviewing appropriate records and damages documentation. + Utilize diary management system to ensure that all claims ...Provide mentoring or training as request by field severity management . + COMMUNICATION/INFLUENCE: + Consult with Manager … more
- Walmart (Stockton, CA)
- …to address audit findings Validates claim records work with workers compensation case managers for investigation of claims Asset Protection Security Possesses ... and waste pollution Supports regulatory visits and prepares audit reports for management review Participates in evaluating pollution control and management at… more
- Ventura County (Ventura, CA)
- … claims staff to ensure adherence to laws, regulations, contractual obligations, and claims management best practices. + Assists the TPA to facilitate review ... programs. The candidate must possess extensive experience in workers' compensation claims administration, rating permanent disability, developing case settlement… more
- Sedgwick (West Hills, CA)
- …mental, physical, financial and professional needs. **PRIMARY PURPOSE** : Provides disability case management and routine claim determinations based on medical ... Refers cases as appropriate to team lead and clinical case management to assist with claim determination....service experience required. One (1) year of benefits or claims management experience preferred. **Skills & Knowledge**… more
- City and County of San Francisco (San Francisco, CA)
- …collaboratively with the Occupational Nurse Consultant, Nurse Manager , and/or Nurse Case Managers to review complex claims and establish medical protocols. ... 13. Advises the Occupational Nurse Manager and/or Consultant on issues related to medical clinic...17. Directs the claims investigation on complex claims . 18. Reviews and approves negotiated case … more