- LA Care Health Plan (Los Angeles, CA)
- …the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Licensed Registered Nurse ( RN ) - Active, current and ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC ...as assigned. Education Required Associate's Degree in Nursing for Registered Nurses Education Preferred Bachelor's Degree in Nursing for… more
- Evolent (Sacramento, CA)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Sacramento County (Sacramento, CA)
- …read and understood the above instructions. 02 Select the one box that best describes your Registered Nurse ( RN ) license issued by the State of California. + ... Registered Nurse D/CF (Level I/II) Print...+ Use and care of medical equipment used in clinical and infirmary settings + Basic medical indications of… more
- Cedars-Sinai (CA)
- …as a condition of continued employment. **Req ID** : 13443 **Working Title** : Registered Nurse Care Coordinator- Inpatient Specialty Program - 8 Hour Days $5K ... care. Use Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas' operations to… more
- CenterWell (Sacramento, CA)
- …to preserve and recover revenue while maintaining the highest level of clinical and regulatory integrity and compliance. Manages the Denials Management data ... and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face,...+ Oversee the process for direction and support to clinical and operational leadership regarding Medicare and governmental audit… more
- Sharp HealthCare (La Mesa, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA...will participate in venues to reduce barriers to discharge.The RN CM Collaborates with Clinical Resource Coordinators… more
- City and County of San Francisco (San Francisco, CA)
- …Registered Nurse ( RN ) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a ... college or university; AND + License and Certification: + Registered Nurse License: Possession of a valid... Nurse Specialist Certification: The clinical nurse specialist is a BRN certified RN … more
- UCLA Health (Los Angeles, CA)
- …self-directed individual with: * Bachelor's degree in health-related field, preferred * A Registered Nurse ( RN ) license or MD diploma (or equivalent) ... at UCLA Health. You will become a member of our highly successful Clinical Documentation Integrity and Denial Management team, including all modalities. This role… more
- University of Southern California (Arcadia, CA)
- …of patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing ... process improvement methodologies in evaluating outcomes of care support and coaching of clinical documentation efforts and serving as a clinical resource for… more
- University of Southern California (Arcadia, CA)
- …requirements impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review/case management in ... for both formal and informal education for physicians, nursing, and other clinical staff. + Meets established productivity targets for record review and appropriate… more