Nurse Supervisor Clinical Appeals
Company: Clinical Management Consultants
Location: San Francisco
Posted on: September 15, 2021
A longstanding hospital in the San Francisco Bay Area is seeking
a Nurse Supervisor for Clinical Appeals. The Clinical Appeals Nurse
Supervisor will work with a well-tenured of utilization review and
case management healthcare professionals that pride themselves
in delivering high quality healthcare to the local community.
This hospital is truly a safety-net hospital for the local
patient population and deliver care to patients both able and
unable to pay.
The Nurse Supervisor Clinical Appeals will coordinate and lead
the appeal process for all facilities clinical appeals and
third-party audits, supervise the Care Management Specialist
workflow for referrals, post hospital appointments and utilization
management activities for inpatients. Daily tasks will
include analyzing and presenting authorizations, referrals,
denials, avoidable days and compiling compliance data for internal
and external stakeholders. A Nurse Supervisor will a thorough
understanding of MediCal and Medicare services will have a smooth
transition into this important leadership position. Moreover,
knowledge of local insurance providers, national payors and
community health services will be beneficial.
The Clinical Appeals Nurse Supervisor will enjoy working in this
dynamic position that is instrumental in the ongoing success of
this large Level I Trauma Center. This hospital is the flagship
hospital in a large integrated healthcare network that
provides care to much of the East Bay and surrounding Oakland
Staff at this medical center come to work everyday excited to
serve this patient population--there is truly a compassionate feel
when walking the halls of this hospital.
Keywords: Clinical Management Consultants, San Francisco , Nurse Supervisor Clinical Appeals, Other , San Francisco, California
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