• Nurse Appeals ( RN )

    Elevance Health (Walnut Creek, CA)
    ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the ... our PulsePoint locations. **Shift:** Monday to Friday from 8:00am-5:00pm PST The ** Nurse Appeals ** is responsible for investigating and processing medical… more
    Elevance Health (12/04/24)
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  • Care Management Clinical Appeals Specialist

    Alameda Health System (San Leandro, CA)
    …at a medical group or health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California, Active BLS - Basic Life ... Care Management Clinical Appeals Specialist + San Leandro, CA + Finance...based on identified criteria and ensures the patient is registered at the appropriate level of care; Utilizes McKesson… more
    Alameda Health System (11/19/24)
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  • San Leandro Hospital Case Manager RN , Full…

    Alameda Health System (San Leandro, CA)
    …Heart Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. **Additional Information** ... San Leandro Hospital Case Manager RN , Full Time, Benefited, Days, 8hrs, 1.0fte +...Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.… more
    Alameda Health System (12/06/24)
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  • AHD Case Manager RN

    Alameda Health System (Alameda, CA)
    …health preferred. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Required Licenses/Certifications: ... AHD Case Manager RN + Alameda, CA + Alameda Hospital +...contacts with payers conducting phone reviews and initiates denial appeals as needed. 4. Conducts discharge planning assessments in… more
    Alameda Health System (11/08/24)
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  • Director, Utilization Management

    Alameda Health System (Oakland, CA)
    …nursing background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Preferred ... of quality improvement initiatives. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals .… more
    Alameda Health System (12/20/24)
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  • Manager, Care Management

    Alameda Health System (Oakland, CA)
    …in a supervisory or lead role. **Required Licenses/Certifications:** Active licensure as a Registered Nurse in the State of California or licensed in Clinical ... and internal compliance studies. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals .… more
    Alameda Health System (11/05/24)
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