- Elevance Health (Walnut Creek, CA)
- ** Nurse Appeals - Licensed RN Nurse...skills and serves as a subject matter expert for appeals /grievances/ quality of care issues and is a resource ... locations. **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and processing medical necessity appeals… more
- Elevance Health (Walnut Creek, CA)
- The CA Nurse Medical Mgmt I is responsible for reviewing and analyzing institutional and professional claims and supporting medical documents to determine medical ... benefits payable according to established guidelines. Ensures medically appropriate, high quality , cost effective care through assessing the medical necessity of… more
- Alameda Health System (Oakland, CA)
- …with the Director of Care Management identifies utilization issues affecting the quality of patient care. + Direct and coordinate data gathering and record ... and internal compliance studies. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals .… more
- Alameda Health System (Oakland, CA)
- …with the Director of Care Management identifies utilization issues affecting the quality of patient care. -Direct and coordinate data gathering and record keeping ... Medicare and internal compliance studies. -Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals… more
- Alameda Health System (San Leandro, CA)
- …other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. 3. Encourages patients to develop realistic plans. Makes ... issues including concerns involving under/over utilization, avoidable days and quality issues. Coordinate daily with interdisciplinary team in transitioning patient… more
- Alameda Health System (Alameda, CA)
- …issues including concerns involving under/over utilization, avoidable days and quality issues. Coordinate daily with interdisciplinary team in transitioning patient ... other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed.** + **Conducts discharge planning assessments in a timely… more
- Highland General Hospital (Alameda, CA)
- …issues including concerns involving under/over utilization, avoidable days and quality issues. Coordinate daily with interdisciplinary team in transitioning patient ... other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Conducts discharge planning assessments in a timely and… more