- 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 + ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...documented on all patient medical records. 6. Coordinates with Care Management team when cases do not… more
- Highland General Hospital (Oakland, CA)
- …Responsible for the recruitment, orientation, evaluation, counseling and disciplinary action of care management clinical and administrative staff. + ... Performs daily clinical rounds and monthly audit of charts on care management activities (utilization review, discharge planning and Interrater Reliability).… more
- Highland General Hospital (Oakland, CA)
- …for the recruitment, orientation, evaluation, counseling and disciplinary action of care management clinical and administrative staff. -Responsible ... daily clinical rounds and monthly audit of charts on care management activities (utilization review, discharge planning and Interrater Reliability).… more
- Elevance Health (Walnut Creek, CA)
- **RVP II Sr Clinical Officer (Commercial)- California** **Location:** **California** **Summary** In this role as the RVP II Sr Clinical Officer for one of our ... business segment. In this role your focus will be clinical expertise, strategic, and cross-functional leadership to drive strategic...determine and improve factors contributing to variations in health care cost and quality while managing a team in… more
- Elevance Health (Walnut Creek, CA)
- …projects and initiatives **Required Qualifications:** + Requires minimum of 3 years acute care clinical experience or case management , utilization ... care and accurate claims payment. May also manage appeals for services denied. **How You Will Make an...territory of the United States. **Preferred Qualifications:** + Acute care clinical experience is a must +… more
- Sutter Health (Berkeley, CA)
- …visitors and each other with courtesy, dignity, respect and professionalism. RELATIONSHIP MANAGEMENT : * Assists physicians and patients with appeals process when ... effective, and cost efficient medication therapy. Exercises sound judgment, and developed clinical skills to provide pharmaceutical support to the patient's plan of … more
- Tiburcio Vasquez Health Center (Hayward, CA)
- …issues, claims reviews, grievances, appeals , and other medical management challenges. Directs and supervises assigned clinical projects. Administrative ... duties and administrative responsibilities. This position involves providing direct patient care , supporting medical providers, and spearheading key clinical … more
- Elevance Health (Walnut Creek, CA)
- …is a benefit- management leader in Illinois. Our platform delivers significant cost-of- care savings across an expanding set of clinical domains, including ... ** Clinical Operations Medical Director** **Utilization Management ...initial nurse review, of Medical Oncology regimens and supportive care . + Perform physician-level case review, following initial nurse… more
- Elevance Health (Walnut Creek, CA)
- ** Clinical Operations Associate Medical Director** **General Orthopedic Surgery** Full Time **_Sign on Bonus: $7,500_** **Location:** This position will work a ... locations with a preference for California. The **Orthopedic Surgery Clinical Operations Associate Medical Director** is responsible for performing… more
- Elevance Health (Walnut Creek, CA)
- …is a benefit- management leader in Illinois. Our platform delivers significant cost-of- care savings across an expanding set of clinical domains, including ... Clinical Operations Associate Medical Director** **Carelon Medical Benefit Management ** **Interventional Pain Benefit Review** **Location** : This position will… more
- Alameda Health System (Alameda, CA)
- …+ Alameda Hospital + AH Care Coordination + Full Time - Day + Care Management + Req #:39260-28832 + FTE:1 + Posted:March 27, 2024 **Summary** **Role ... health deterioration and reduce the need for more costly services such as acute care hospitalization and to develop self- management skills that improve his or… more
- Highland General Hospital (Alameda, CA)
- …health deterioration and reduce the need for more costly services such as acute care hospitalization and to develop self- management skills that improve his or ... care ; continued stay criteria for medical necessity and appropriateness of care ; resource Management issues; other issues including concerns involving… more
- Sutter Health (Berkeley, CA)
- …with managed care and coding departments to maintain accuracy in clinical and billing information. **Job Description** : PATIENT ADVOCATE SERVICES: + Verifies ... visitors and each other with courtesy, dignity, respect and professionalism. RELATIONSHIP MANAGEMENT : + Assists physicians and patients with appeals process when… more