Elevance Health jobs
Nurse Appeals (RN) CA
Nurse Appeals – Licensed RN Nurse
Location: This position will work in a hybrid model (remote and office). Ideal candidates will live in the state of California within 50 miles of one of our PulsePoint locations.
Shift: Monday to Friday from 8:00am-5:00pm PST
The Nurse Appeals is responsible for investigating and processing medical necessity appeals requests from members and providers.
How you will ...
Manager I GBD Special Programs
Manager I GBD Special Programs
Office Location: 21215 Burbank Blvd, Woodland Hills, CA 91367.
Office Requirement: This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days physically in office per week.
The Manager I GBD Special Programs is responsible for managing and overseeing team responsible for coordination of a comprehensive health care program in...
LTSS Service Coordinator
LTSS Service Coordinator
Location: Candidate should reside in California and be within 50 miles of one of our PulsePoint locations (Cerritos, Costa Mesa, LA, Palo Alto, Rancho Cordova, Sacramento, Walnut Creek, or Woodland Hills). This is a hybrid position, candidate will need to work in office at least one day a week.
The LTSS Service Coordinator is responsible for conducting service coordination functions for a defined caseload of individuals ...
Primary Care Physician- Los Angeles, California
Primary Care Physician
Location: Physician will rotate between 303 S Union Ave., Los Angeles, California clinic location and 2444 W Beverly Rd. Montebello, California clinic location with the goal to transition to one location once the patient panel is built up.
***$15,000 Sign-on Bonus***
Responsible for providing Internal Medicine/Family Practice Services to patients.
How you will make an impact:
Primary Care Physician- Downey, California
Primary Care Physician- Downey, California
Location: 10000 Lakewood Blvd. Downey, California clinic location.
***$15,000 Sign-on Bonus***
Responsible for providing Internal Medicine/Family Practice Services to patients.
How you will make an impact:
Provides medical patient care by interviewing, examining, and treating clinical patients.
Educates patients and families on...
LTSS Service Coordinator
LTSS Service Coordinator
Location: Candidate should reside in California and be within 50 miles of one of our PulsePoint locations (Cerritos, Costa Mesa, LA, Palo Alto, Rancho Cordova, Sacramento, Walnut Creek, or Woodland Hills). This is a hybrid position, candidate will need to work in office at least one day a week.
The LTSS Service Coordinator is responsible for conducting service coordination functions for a defined caseload of individuals ...
Nurse and CPC – Clinical Fraud Investigator II – SIU Fraud & Abuse
Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & Abuse
Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
Hybrid Workplace Strategy: 1-2 days in office per week
The Clinical Fraud Investigator II is responsible for identifying issues and/or entities that may pose potential risks associate...
Med Mgmt Clinician Sr (US)
The Med Mgmt Clinician Sr is responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or medical policies. May collaborate with healthcare providers. Focuses on relatively complex case types that do not require the training or skill of a registered nurse. Acts as a resource for more junior Clinicians. Approval decisions may be subject to review by more senior ...
Associate Medical Director – Sleep Medicine
We are currently seeking a versatile Board Certified Physician to participate in pre-authorization reviews of high-tech diagnostic imaging, cardiac testing and sleep management services. Medical Directors in Clinical Operations determine the medical necessity of outpatient radiology, cardiology, sleep management, endoscopies and surgical site of care requests using clinical guidelines, state mandates, health plan medical policy and Medicare Coverage Determinations.
The
Diagnosis Related Group Clinical Validation Auditor-Registered Nurse
Diagnosis Related Group Clinical Validation Auditor-Registered Nurse
Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.
The Diagnosis Related Group Clinical Validation Auditor is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in re...