- Molina Healthcare (San Bernardino, CA)
- …medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse ... and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical … more
- Alameda Health System (Oakland, CA)
- …of quality improvement initiatives. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals . ... post-acute and psych; three years of InterQual and/or MCG. Strong clinical nursing background. Required Licenses/Certifications: Valid license to practice as a… more
- Sharp HealthCare (San Diego, CA)
- …**Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree in Nursing; ... care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure patients are… more
- Sharp HealthCare (La Mesa, CA)
- …Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours** **:** **Shift Start ... care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure patients are… more
- City and County of San Francisco (San Francisco, CA)
- …class is a first line supervisor responsible for providing leadership on clinical standards for Mental Health Rehabilitation Workers, Licensed Vocational Nurses and ... of staff and program needs; + Participates in establishing clinical standards; inputs on unit issues; + Makes shift...as a Licensed Psychiatric Technician or a Licensed Vocational Nurse providing psychiatric nursing care in a skilled facility… more
- Cedars-Sinai (Beverly Hills, CA)
- …care. Use Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas' operations to ... Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy. + Begins… more
- Alameda Health System (San Leandro, CA)
- …other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic plans. Makes ... care facility and/or utilization review training. Minimum Experience: Varied clinical experience or experience in case management/community health preferred.… more
- City and County of San Francisco (San Francisco, CA)
- …be required. ** Under the direction of a licensed physician, registered nurse , or clinical supervisor, the Psychiatric Technician performs professional ... 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… more