- Elevance Health (Woodland Hills, CA)
- ** Nurse Appeals - Licensed Nurse ** **Location:** *The ideal candidate must reside in the state of California and live within 50 miles of our Woodland Hills ... locations. **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Elevance Health (Woodland Hills, CA)
- The Nurse Medical Mgmt I is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to ... in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Primary duties may include, but are not limited to:… more
- Universal Health Services (Riverside, CA)
- …relevant QI studies, and coordinate CPPI. Review/respond to grievances and appeals , monthly medication inventory audit, and monitor any other quality indicators. ... education degree (GED) required. Current California licensure as a Licensed Vocational Nurse . Graduate of accredited school of Licensed Vocational Nursing. One (1)… more
- Elevance Health (Woodland Hills, CA)
- …and providers. **Job Summary:** + Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care. + Perform ... physician-level case review, following initial nurse review, of chemotherapy regimens. + Determine medical necessity...a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations.… more
- Prime Healthcare (Ontario, CA)
- …Service, to provide guidance on complex Authorizations, Referrals, Denials and Appeals . + Integrates and coordinates services using continuous quality improvement ... or Case Management with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA) certificate upon hire and maintain current + Analytical… more
- Elevance Health (Woodland Hills, CA)
- …for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of medical ... or policy interpretation. + Perform physician-level case review, following initial nurse review, of sleep studies, durable medical equipment, and high-tech… more