- Elevance Health (Palo Alto, CA)
- ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the state of ... 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 (Palo Alto, CA)
- ** Nurse Appeals - California candidates only** **Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health ... **Schedule: Tuesday - Saturday 9:00am to 5:30 pm PST.** The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Stanford Health Care (Palo Alto, CA)
- …Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will be responsible for ensuring the efficient and effective ... to optimize patient outcomes and manage healthcare costs. 4. Denials and Appeals Management: Address and manage denials by reviewing cases, gathering relevant data,… more
- Stanford Health Care (Palo Alto, CA)
- …stay review, retrospective review of care, medical claims review, addressing denials/ appeals and grievances effectively and timely, and compliance with payer and ... utilization management, concurrent review, prior authorizations medical claims review, appeals and grievances functions. + Establishes and measures productivity… more
- Alameda Health System (Oakland, CA)
- …and internal compliance studies. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals . ... 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
- Alameda Health System (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
- 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 ... in case management/community health preferred. Preferred Licenses/Certification: Public Health Nurse , Case Management, or Home Health. Required Licenses/Certifications: BLS… 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
- Stanford Health Care (Palo Alto, CA)
- …Resource Management/ Clinical Cost Efficiency, Financial Assistance/Referrals, Appeals Management, Entitlement Program Coordination, Patient Benefits Coordination: ... Medical Social Worker - State Licensure or + Nursing / RN - Registered Nurse - State Licensure and/or Compact State Licensure **These principles apply to ALL… more