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Nurse Supervisor Clinical Appeals

Company: Clinical Management Consultants
Location: San Francisco
Posted on: September 15, 2021

Job Description:

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 communities.

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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