- Elevance Health (Walnut Creek, CA)
- ** Nurse Appeals - California candidates only** **Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health ... make an impact:** Responsible for investigating and processing and medical necessity appeals requests from members and providers. **Primary duties may include, but… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California, Active BLS -… more
- Highland General Hospital (Oakland, CA)
- …and internal compliance studies. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals . ... a supervisory or lead role. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California or licensed in Clinical Social Work… more
- Highland General Hospital (Oakland, CA)
- …Medicare and internal compliance studies. -Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals ... a supervisory or lead role. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California or licensed in Clinical Social Work… more
- Elevance Health (Walnut Creek, 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
- Alameda Health System (Alameda, CA)
- …other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed.** + **Conducts discharge planning assessments in a timely ... **Required Licenses/Certifications:** **Valid license to practice as a Registered Nurse in the State of California.** **Required Licenses/Certifications:** **BLS -… more
- Highland General Hospital (Alameda, CA)
- …other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Conducts discharge planning assessments in a timely and ... preferred. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Required Licenses/Certifications: BLS -… more
- Elevance Health (Walnut Creek, 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
- Sutter Health (Berkeley, CA)
- …Enters supporting data into comment box. Communicates with supervisor or charge nurse , physicians, practice staff when there are issues with authorization. ONCOLOGY: ... and professionalism. RELATIONSHIP MANAGEMENT: + Assists physicians and patients with appeals process when treatment is denied. + Meets with pharmaceutical drug… more