- Elevance Health (Palo Alto, CA)
- ** Nurse Appeals ( Quality ) - California candidates only** **Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance ... + Utilizes leadership skills and serves as a subject matter expert for appeals /grievances/ quality of care issues and is a resource for clinical and non clinical… more
- Elevance Health (Palo Alto, 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
- 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 ... use of healthcare resources while promoting quality patient care. Working in collaboration with Physician Advisors,...patient outcomes and manage healthcare costs. 4. Denials and Appeals Management: Address and manage denials by reviewing cases,… 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)
- …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
- Stanford Health Care (Palo Alto, CA)
- …patient assessment and patient care and participate in program development and quality improvement initiatives. In their role, Care Managers, by applying guidelines ... and collaborating with multidisciplinary teams, influence and direct the delivery and quality of patient care. Care Managers are assigned to a group of patients by… more