- 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
- Elevance Health (Walnut Creek, CA)
- …locations. **Expected Work Hours:** Monday-Friday; 8am-5pm PST The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and ... clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and...clinical services, quality of service and quality of care issues including executive and regulatory grievances. + Oversees… more
- Elevance Health (Walnut Creek, CA)
- …of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management , a ... for autism and depression, and insightful analytics to improve the delivery of care . The ** Clinical Ops Associate Medical Director - Ortho** is responsible… more
- Alameda Health System (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
- Stanford Health Care (Palo Alto, CA)
- … Care , Health Care Resource Management / Clinical Cost Efficiency, Financial Assistance/Referrals, Appeals Management , Entitlement ... Education & Training, Risk Management Identification & Referral + Clinical Care Coordination/Facilitation: Plan of Care & Outcomes Management ,… more
- Alameda Health System (Oakland, CA)
- …to ad hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care . **DUTIES & ESSENTIAL JOB ... Director, Utilization Management + Oakland, CA + Highland General Hospital...trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician collaboration, and aligns with organizational… more
- Alameda Health System (San Leandro, CA)
- …CA + San Leandro Hospital + SLH Social Services + Full Time - Day + Care Management + Req #:40181-29621 + FTE:1 + Posted:December 10, 2024 **Summary** **Job ... 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
- Elevance Health (Walnut Creek, CA)
- … healthcare management and interdisciplinary team in order to provide care coordination support. + Manages non- clinical needs of members with chronic ... + Uses tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential… more
- Alameda Health System (Alameda, CA)
- …+ Alameda Hospital + AH Care Coordination + Full Time - Day + Care Management + Req #:40760-30098 + FTE:1 + Posted:November 7, 2024 **Summary** **SUMMARY:** ... 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
- Elevance Health (Walnut Creek, CA)
- …of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management , a ... for autism and depression, and insightful analytics to improve the delivery of care . The ** Clinical Ops Associate Medical Director** is responsible for… more