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Case Manager Jobs in Pleasanton, California

326 jobs

Description Responsible for handling the review process for grievances, appeals, or denials including investigating, preparing and presenting appropriate materials for review. Resolves member concerns in partnership with internal and external departments while ensuring compliance with regulatory rules and timeframes.within mandated timeframes and compliance. Essential Functions: • Participates ...

Description Position located within Correspondence center, reporting to Correspondence Center Team Lead or to Correspondence Center Assistant Director. Responsible for handling member concerns through research and communication with involved departments / member. Partner with internal and external departments and staff to achieve resolution for member concerns. Manage database for cases. Responsi...

Description Responsible for handling the review process for grievances, appeals, or denials including investigating, preparing and presenting appropriate materials for review. Resolves member concerns in partnership with internal and external departments while ensuring compliance with regulatory rules and timeframes.within mandated timeframes and compliance. Essential Functions: • Participates ...

Description Supervises the member case grievances and appeals processes to ensure compliance with government and internal organizational regulations and guidelines. Essential Functions: • Oversees the day to day processing of case complaints, grievances and appeals regarding health plan claims and services filed by members. Expedites, tracks and facilitates grievances and appeals processing act...

Responsible for handling the review process for grievances, appeals, or denials including investigating, preparing and presenting appropriate materials for review. Resolves member concerns in partnership with internal and external departments while ensuring compliance with regulatory rules and timeframes.within mandated timeframes and compliance. Essential Functions: • Participates in handling t...

Supervises the member case grievances and appeals processes to ensure compliance with government and internal organizational regulations and guidelines. Essential Functions: • Oversees the day to day processing of case complaints, grievances and appeals regarding health plan claims and services filed by members. Expedites, tracks and facilitates grievances and appeals processing activities inclu...

Reproductive Science Center of the Bay Area (RSC). Join our practice to help make a difference! We are growing and looking for full time Registered Nurse to care for our In-vitro fertilization patients in our Orinda office location. Our practice environment is very innovative and exciting, patient satisfaction is excellent, and success rates are as well! This is an opportunity to work in the fiel...

Description Responsible for carrying out case management activities for IPA members referred to the case management program across all levels of care. Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services required to meet the client’s health and human service needs. It is characterized by advocacy, communication and ...

Nurse Case Manager Field based position in the Fremont Area working from a home office ISYS rewards professionalism and initiative. When you succeed, ISYS succeeds! Excellent benefits: Strong compensation, benefits package with tax deferred retirement program, flexibility in schedule, medical, dental and vision insurance, and long term disability insurance. Highest compensation in the industry...

CYPRESS INDEPENDENT LIVING SERVICES: About Us: Cypress ILS provides its clients with various services focused on such aspects as basic skills development, community awareness, and employment training. But, it is not simply in the attainment of a job, or arriving at a doctor's appointment on one's own that Cypress seeks for its clients. All the services are geared towards one main goal, the philo...

Reproductive Science Center of the Bay Area (RSC). Join our practice to help make a difference! We are growing and looking for full time Registered Nurse to care for our In-vitro fertilization patients in our Orinda office location. Our practice environment is very innovative and exciting, patient satisfaction is excellent, and success rates are as well! This is an opportunity to work in the fiel...

CYPRESS INDEPENDENT LIVING SERVICES: About Us: Cypress ILS provides its clients with various services focused on such aspects as basic skills development, community awareness, and employment training. But, it is not simply in the attainment of a job, or arriving at a doctor's appointment on one's own that Cypress seeks for its clients. All the services are geared towards one main goal, the philo...

Description Coordinates with physicians, staff, and non-Kaiser providers and facilities regarding patient care. In conjunction with physicians, develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost-effective protocols, and develops guidelines for care. Essential Functions: • Utilization Management: Per...

Travel RN - Registered Nurse Case Manager Case Manager Travel RN: Registered Nurse-Case Management trustaff currently travel position available for a Case Manager RN. This assignment is for an immediate start with a reputable facility seeking an experienced RN to fill a 13-week contract in their intensive care unit. Start Date: Immediate Start Multiple Shifts Available. This opportunity offer...

Assures appropriate resource allocation and optimal quality medical care for patients of all ages from the time of admission until discharge. Coordinates discharge planning for a limited volume of patients on either the assigned unit or in other areas as requested. The primary patient populations involve as adult, geriatric and adolescent patients. RN license, Bachelor's degree preferred, 3 yrs ex...

Assures appropriate resource allocation and optimal quality medical care for patients of all ages from the time of admission until discharge. Coordinates discharge planning for a limited volume of patients on either the assigned unit or in other areas as requested. The primary patient populations involve as adult, geriatric and adolescent patients. RN license, Bachelor's degree preferred, 3 yrs ex...

Case Manager - RN Spanish Speaking Required-1500312 About WellCare: WellCare Health Plans, Inc. is a Fortune 500 company traded on the New York Stock Exchange (symbol: WCG). It provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offer...

Case Management Specialist CLAIM YOUR FUTURE AS A GREAT PERFORMER! Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking a place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the ...

Registered Nurse Manager job in ER unit available in Castro Valley, CA! This 13-week travel assignment is looking for a RN with: - CA RN license - 2 years Utilization Review experience - 2 years Acute Care Case Management experience Cirrus Medical Staffing partners with our travel nurses to customize a financial package that maximizes their income. Our benefits include but are not limited to:...

Manager Marketing Product Management – Business Intelligence-NAV000262 Danaher Company Description Danaher Corporation (NYSE:DHR), a Fortune 150 company, purchased and combined two of the premier fleet tracking companies thereby forming the second largest global fleet tracking company in the world. Operating under the Navman Wireless and Teletrac brands, with a combined base of over 40,000 custom...