- Centene Corporation (Sacramento, CA)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... to work M-F 8-5 PST Hours. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...Licensed Practical Nurse - State Licensure required or + LVN - Licensed Vocational Nurse required or + RN… more
- Evolent (Sacramento, CA)
- …adjudication of processed appeals . **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or ... for the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part… more
- Molina Healthcare (Long Beach, CA)
- …Delegation Oversight Manager with additional duties of the team. We are looking for LVN 's with at least 4 years of UM experience, NCQA accreditation, and knowledge ... in this role. Productivity is important with quick turnaround times. Experience with Appeals , Auditing, and Compliance /Quality will be a good fit for this position.… more
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …of the Utilization Review Specialist is to review medical records and prepare clinical appeals (when appropriate) on medical necessity, level of care, length ... requirements for the position such as a High School Diploma and a current California LVN License we're really looking for people who bring their HEART to work. If… more