- CenterWell (Sacramento, CA)
- …and compliance. Manages the Denials Management data analytics, denial and appeal process. The Director , Home Health Grievances & Appeals assists members, ... part of our caring community and help us put health first** The Director Denials Management provides...related field + 10-15 years progressively responsible experience in home health or hospice industry that includes… more
- Molina Healthcare (CA)
- …reviews Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization ... corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees… more
- Dignity Health (Sacramento, CA)
- …health clinic for victims, the Human Trafficking Medical Home . One Community. One Mission. One California (https://youtu.be/RrPuiSnALJY?si=pvQgPZ6ZWZM60TPV) **Pay ... Skilled Nursing Care. Coordinate discharge planning, including arranging services, ensuring home safety, and securing community resources The incumbent will plan,… more
- Evolent (Sacramento, CA)
- …requests and/or relevant health care experience in claims or appeal & grievances is required. + Ability to read, write and speak the English language fluently ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...work collaboratively with other Utilization Management Leaders including our Director may also be available. **What You Will Be… more
- Cedars-Sinai (Beverly Hills, CA)
- …inpatient or outpatient settings preferred; knowledge of HMO and Medicare rules in inpatient, home health and at the SNF settings preferred + Knowledge of ... Express) no later than date of discharge. + Communicates regularly with CSMPN Medical Director , Employee Health Services, Risk Management, and TPA + Attends all… more
- City and County of San Francisco (San Francisco, CA)
- …and county services, from public safety to transportation to street maintenance to public health , and much more. San Francisco is a vibrant and dynamic city, on the ... bargaining agreements. + Key duties include negotiating resolutions to grievances , investigating complaints of serious employee misconduct, and conferring with… more