- Elevance Health (Los Angeles, CA)
- ** Appeals Nurse Reviewer I**...Outreach to providers with appeal process instructions. + Clinical review for the RBM and Surgical solution on a ... set of clinical domains, including radiology, cardiology and oncology. The ** Appeals Nurse Reviewer I** is responsible for conducting preauthorization, out… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- Cognizant (Sacramento, CA)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse D/CF Salary ... 5:00 pm on: 2/3/25, 4/7/25, 6/2/25, 8/4/25, 10/6/25, 12/1/25 Supervising Registered Nurse - Detention/Correctional Facility is the first level supervisory class in… more
- Sacramento County (Sacramento, CA)
- Licensed Vocational Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448956) Apply Licensed Vocational Nurse D/CF Salary ... 4/3/2026, 7/2/2026, 10/2/2026 In a detention/correctional facility, the Licensed Vocational Nurse D/CF performs a wide variety of vocational nursing duties,… more
- Sacramento County (Sacramento, CA)
- Supervising Public Health Nurse Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/600083) Apply Supervising Public Health Nurse Salary ... One year of experience as a Senior Public Health Nurse in Sacramento County service. Or: Two years of...improperly rejected may request the Employment Services Division to review its decision to reject the application. If the… more
- Sacramento County (Sacramento, CA)
- Nurse Practitioner Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1780920) Apply Nurse Practitioner Salary $132,483.60 - $161,026.56 ... 9/26/2025, 10/24/2025, 11/26/25, 12/26/25, 1/23/26, 2/27/26, 3/27/26, 4/24/26, 5/22/26, 6/26/26 Nurse Practitioners provide a range of health care services involving… more
- Sacramento County (Sacramento, CA)
- Registered Nurse D/CF (Level I/II) Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/454059) Apply Registered Nurse D/CF (Level I/II) ... at 5:00 pm on: 5/8/2025, 7/3/2025, 9/4/2025, 11/6/2025 Registered Nurse D/CF Level I: $61.27 - $74.48 hourly Registered...improperly rejected may request the Employment Services Division to review its decision to reject the application. If the… more
- Stanford Health Care (Palo Alto, CA)
- … review , assessing the likelihood of a successful appeal. + Proofreading and Editing: Review and edit appeals for clarity and accuracy prior to submission to ... the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position requires strong… more
- Prime Healthcare (Ontario, CA)
- …for a Health Plan. + At least 3 years of experience in utilization review , referrals, authorizations, denials and appeals . + Current BCLS (AHA) certificate upon ... cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the medical necessity,...accredited school of nursing and a current state Registered Nurse license. + Minimum 3 years RN Utilization Manager… more
- City and County of San Francisco (San Francisco, CA)
- …this announcement may be appealed under Civil Service Rule 111A.35.1. The standard for the review of such appeals is 'abuse of discretion' or 'no rational basis' ... anesthesia; and performs related duties as required. The Certified Registered Nurse Anesthetist (CRNA) requires responsibility for: carrying out established methods… more
- Alameda Health System (Oakland, CA)
- …development and implementation of quality improvement initiatives. + Oversees the secondary review process; actively appeals denied cases when necessary and ... classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. +...assists physicians with appeals . Maintains minimal denial rates by Medicare, MediCal, private… more
- Molina Healthcare (San Bernardino, CA)
- …the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
- Sacramento County (Sacramento, CA)
- …of California to practice as a: Either: 1. Psychiatric Technician Or: 2. Registered Nurse Or: 3. Vocational Nurse Note: The word "experience" referenced in the ... improperly rejected may request the Employment Services Division to review its decision to reject the application. If the...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more
- Sacramento County (Sacramento, CA)
- …Licensed Clinical Social Worker, Marriage and Family Therapist, or Registered Nurse . AND Either: Two years of experience coordinating and/or supervising mental ... Two years of experience in the class of Mental Health Counselor, Psychiatric Nurse , Senior Mental Health Counselor, Senior Psychiatric Nurse , or Supervising… more
- The County of Los Angeles (Los Angeles, CA)
- …grievances and disciplinary problems. Other positions are assigned such functions as: review and analysis of State, Federal and local legislation and regulations ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more
- Sharp HealthCare (San Diego, CA)
- …advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers. Review all cases with readmission within ... **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree in Nursing;… more
- Sharp HealthCare (La Mesa, CA)
- …advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers. Review all cases with readmission within ... Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours** **:** **Shift Start… more
- Cedars-Sinai (Beverly Hills, CA)
- …their needs, coordinating care, communicating with health plans, including concurrent review to determine the appropriateness of services rendered and to ensure ... of care and level of care. Use evidence based review guidelines to conduct utilization review as...and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy.… 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 ... Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or experience in case… more