- Providence (Torrance, CA)
- **Description** ** Appeals RN - Care Manager...Degree Nursing. + Upon hire: California Registered Nurse License. + 2 years Direct patient care ... Per Diem and will work 8-hour, Day shifts.** The Care Management Recovery Advocate (CMRA) is responsible...management certification. + Experience working with denials and appeals in/for an acute care setting. +… 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 ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- 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:... appeals and grievances experience in a managed care , utilization management and/or case management… more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse ... 5:00 pm on: 12/1/25, 2/2/26, 4/6/26, 6/1/26, 8/3/26, 10/5/26, 12/7/26 Supervising Registered Nurse - Detention/Correctional Facility is the first level… more
- Cognizant (Sacramento, CA)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact... management experience with managed health care plan . 3 years' experience in health … more
- Humana (Sacramento, CA)
- …MRM, SRO **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the (appropriate state) with no disciplinary ... community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
- Stanford Health Care (Palo Alto, CA)
- …180 Days or + CCDS - Cert Clinical Document Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred ... (United States of America) **This is a Stanford Health Care job.** **A Brief Overview** Clinical Government Audit Analyst...plays a critical role in the Revenue Cycle Denials Management Department by managing and resolving clinical appeals… more
- Sharp HealthCare (La Mesa, CA)
- …**Required Qualifications** + 3 Years Recent acute care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA ... Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA...Cerner), and case management software (eg, Allscripts Care Management ).The RN CM will… more
- Cedars-Sinai (Beverly Hills, CA)
- …innovation. **A Little More About What You Will be Doing** The RN Care Coordinator is responsible for the case management of patient while hospitalized and ... collaboration with the Inpatient Specialty Program (ISP) hospitalists, the RN Care Coordinator will assist patients from...nursing (Medical Surgical/Tele/ICU) with 2 or more year of care management experience (UM or DC Planning).… more
- Genesis Healthcare (Los Angeles, CA)
- …for the clinical, administrative, and financial oversight of the territory's center-based care management staff. This position oversees the personnel and ... educational tools and materials that are needed to achieve care management goals. 9. Works collaboratively with...and outstanding clinical accounts as needed and generates clinical appeals when necessary. 15. Assists with and completes special… more
- Sacramento County (Sacramento, CA)
- …of Supervising Public Health Nurse : + Must possess and maintain a current Registered Nurse License and Public Health Nurse Certificate issued by the ... , growth, and development, including common illnesses + Case management techniques and the care and treatment...to this class must possess and maintain a current Registered Nurse license and Public Health … more
- Sharp HealthCare (San Diego, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...will collect and document avoidable day's information in appropriate care management software.The RN CM… more
- The County of Los Angeles (Los Angeles, CA)
- …when needed to carry out job-related essential functions. A license to practice as a Registered Nurse issued by the California Board of Registered Nursing** ... supervision to a field staff responsible for surveying health care facilities and enforcing licensing and certification standards in...Certificate Section of the application is completed for the Registered Nurse License. Provide the title of… more
- Sacramento County (Sacramento, CA)
- …Psychiatrist, Psychologist, Licensed Clinical Social Worker, Marriage and Family Therapist, or Registered Nurse . AND Either: Two years of experience coordinating ... + Questions The Position There is an additional 3.35% Management Differential which is added to the posted salary...Psychologist, Licensed Clinical Social Worker, Marriage Family Therapist, or Registered Nurse . Note: Failure to maintain a… more
- The County of Los Angeles (Los Angeles, CA)
- …LICENSE: A valid, active license (without limitations or restrictions) to practice as a Registered Nurse issued by the State of California Board of Registered ... ensure the License and Certificate Section of the application is completed for the Registered Nurse License. Provide the title of your required license and… more
- Alameda Health System (Oakland, CA)
- …nursing background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Preferred ... to ad hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care . **DUTIES & ESSENTIAL JOB… more
- Sacramento County (Sacramento, CA)
- …Employment Qualifications Minimum Qualifications Possession of a current valid license as a Registered Nurse and a Nurse Practitioner certification issued by ... care services involving diagnosis, assessment, treatment, and clinical management of patients in a public health center or...must submit a copy of both my current valid Registered Nurse license AND my Nurse… more
- Elevance Health (Walnut Creek, CA)
- …resources. + Applies clinical knowledge to work with facilities and providers for care -coordination. + May also manage appeals for services denied. + Serves ... **Manager II Medical Management ** **Location:** This role requires associates to be...policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs… more