- Cognizant (Sacramento, CA)
- …need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… 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 ... (A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances… more
- Actalent (Sacramento, CA)
- Job Title: Appeals and Grievances Registered Nurse Job Description We are seeking a skilled professional to join our team and handle member appeals and ... and post-service concerns, reviewing medical records and documentation to evaluate appeals , conducting timely and accurate first-level clinical reviews using… more
- Sacramento County (Sacramento, CA)
- Registered Nurse D/CF (Level I/II) Print...+ Use and care of medical equipment used in clinical and infirmary settings + Basic medical indications of ... (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/454059) Apply Registered Nurse D/CF (Level I/II) Salary $62.99 - $80.17 Hourly Location… 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 ... assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other related duties as assigned/required. Minimum… more
- City and County of San Francisco (San Francisco, CA)
- …experience. + One (1) year (equivalent to 2,000 hours) of experience as a Registered Nurse on a psychiatric inpatient unit, psychiatric emergency service clinic ... of the multidisciplinary health care team and performs specialized nurse practitioner duties in clinical settings. The...Practitioner (NP) license issued by the California Board of Registered Nursing; AND + LICENSE*: Possession of a current… 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 ... of health care services involving diagnosis, assessment, treatment, and clinical management of patients in a public health center...must submit a copy of both my current valid Registered Nurse license AND my Nurse… more
- Sacramento County (Sacramento, CA)
- …status. + None + Basic Life Support (BLS) / Cardiopulmonary Resuscitation (CPR) + Registered Nurse in California + Advanced Cardiac Life Support + Certified ... Licensed Vocational Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448956) Apply Licensed Vocational...+ Use and care of medical equipment used in clinical and infirmary settings + Basic medical indications of… more
- CVS Health (CA)
- …licensure in non-compact states as needed. + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of ... and other key stakeholders such as Medical Directors, account teams/ clinical liaisons, etc.) to ensure consistency in clinical... Appeals experience in Utilization Management + Must have experience… more
- Sacramento County (Sacramento, CA)
- …Psychologist, Licensed Clinical Social Worker, Marriage and Family Therapist, or Registered Nurse . AND Either: Two years of experience coordinating and/or ... Clinical Social Worker, Marriage Family Therapist, or Registered Nurse . Note: Failure to maintain a...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more
- Sharp HealthCare (San Diego, CA)
- …Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California Registered Nurse (RN) - CA Board of Registered Nursing; ... case management experience or equivalent experience in the healthcare setting. + California Registered Nurse (RN) - CA Board of Registered Nursing… more
- Sharp HealthCare (La Mesa, CA)
- …End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing ... + 3 Years Recent acute care nursing experience or case management experience. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred… 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 ... of quality improvement initiatives. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals .… more
- Select Medical (Los Angeles, CA)
- …City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) - 8 hr shifts Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) **Pay Rate: $50 ... process. The primary job functions in Case Management include: Clinical Interventions/Discharge and Care Planning Management; Fiscal Management; and Payer/Referral… more
- Alameda Health System (San Leandro, CA)
- …AHA-American Heart Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. **PAY RANGE** ... other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic plans. Makes… more
- Prime Healthcare (Ontario, CA)
- …7 years Post Graduate of an accredited school of nursing and a current state Registered Nurse license. + Minimum 3 years RN Utilization Manager working for a ... methodology is designed to facilitate and insure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive review… more
- City and County of San Francisco (San Francisco, CA)
- …holiday shifts may be required. ** Under the direction of a licensed physician, registered nurse , or clinical supervisor, the Psychiatric Technician performs ... The terms of this announcement may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department of Human Resources, 1 S… more