- Excellent interpersonal, verbal and written communication skills, particularly telephone.
- Strong analytical and organizational skills with the ability to multi-task.
- Must have the ability to work independently and meet deadlines with attention to detail.
- Excellent time management and organizational skills.
- Must have a good understanding of medical terminology with ability to read, discuss and understand patient medical information.
- Must have the ability to interact effectively with a variety of people and situations at all levels of the organization.
- Ability to stay current on changing governmental and payor regulations related to authorization/certification processes.
- Knowledge of and adherence to commercial, managed care, government and audit appeal processes and timelines and the financial implications to the Ministry.
- Ensures knowledge is kept relevant on all nationally recognized Payor Criteria guidelines.
- Maintains technical knowledge and skills of computer system including but not limited to Office 365, EPIC and Payor based websites.
- Ability to fully utilize automation to achieve departmental goals.
- Ability to demonstrate personal qualities such as kindness, compassion, understanding, creativeness, integrity, interest, influence and respect for others.
- Position requires the ability to push, pull, and/or lift 50 lbs on a regular basis.
- Position requires prolonged standing and walking during each shift.
- Position requires the ability to grip, reach, bend, kneel, twist, and squat to perform duties.
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We are seeking an experienced Nurse Manager to lead our clinical team. The successful candidate will have experience in OR leadership and be able to build a high-performing team. · ...
Fresno1 month ago
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Job Description: · This job description applies to Nurse Manager and Nurse Manager-Complex. · The difference is the scope level below. · This role involves managing and supervising nursing departments. Collaborating with nursing leaders and other facility managers and departments ...
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Employment Type · Full time · Shift · Description: · This position has twenty-four hour accountability for managing all aspects of patient care in the assigned area(s), coordinating the level of care with identified patient needs, providing clinical and material support to staff, ...
Fresno, CA $85,000 - $135,000 (USD) per year6 days ago
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· RN Manager, Emergency · Join Our Team as an RN Manager, Emergency · Location: Central California, CA area · Are you a dynamic leader with a passion for emergency care? Do you thrive in a fast-paced environment, ready to make a real impact in healthcare? If so, we invite you to ...
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The LVN plays a vital role in ensuring the health and well-being of EPOCH residents. · Coordinate with physicians, case managers, and behavioral health providers to ensure continuity and consistency in care · Participate in care team meetings and contribute to interdisciplinary t ...
Fresno, CA1 month ago
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Hospitals on Incredible Health are actively hiring and accepting applications in the Fresno, CA area for the following position: Nurse Case Manager (RN). Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utiliza ...
Fresno $65,000 - $110,000 (USD) per year4 days ago
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· Position Summary · The LVN plays a vital role in ensuring the health and well-being of EPOCH residents. This position focuses on coordinating patient care, managing healthcare resources, and supporting treatment adherence. The LVN will work closely with onsite case managers, ...
Fresno, CA $65,000 - $105,000 (USD) per year1 week ago
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Find your calling at MercyThis position is designed to facilitate an effective process of the new care model; supporting quality patient care, safety and financial components; promoting integration of a seamless care model; collaborating to include coordination as evidenced by me ...
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Foster Farms is looking for an Occupational Health Nurse to maintain required certifications and provide medical and non-medical training. The role involves case management, OSHA recordkeeping, new hire orientation, ergonomics and more. · ...
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Foster Farms has been serving families since 1939. · ...
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Reporting to the Director Telemetry & Cardiovascular Services, Nursing Service Admin, this position has twenty-four hour accountability for managing all aspects of patient care in the assigned area(s), coordinating the level of care with identified patient needs, providing clinic ...
Fresno $67.16 - $100.75 (USD)1 month ago
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The job of Nurse Manager is to lead and manage surgical services in a community hospital. They are responsible for building high-performing clinical teams and providing necessary leadership coaching. · BUILD A HIGH PERFORMING CLINICAL TEAM. · PERFORMS STAFFING AND EVALUATIONS. · ...
Fresno2 weeks ago
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Foster Farms has been serving families since 1939 and is always looking for talented individuals to join the Foster Farms Team. · Maintain required certifications along with knowledge, skills, and expertise through professional development activities. · Schedule Workers' Compensa ...
Fresno $108,200 - $135,250 (USD)1 month ago
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Foster Farms is always looking for talented individuals to join the Foster Farms Team. We offer the experience of a large organization, however operate like a family business. · ...
Fresno $108,200 - $135,250 (USD)1 month ago
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Foster Farms has been serving families since 1939. Since the founding days, Foster Farms has always been committed to providing consumers with the highest-quality, best-tasting poultry products available. · Maintain required certifications along with knowledge, skills, and expert ...
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Join a team that makes a real difference for individuals recovering from work-related injuries. · ...
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This position manages all aspects of patient care in the assigned area(s), coordinating level of care with identified patient needs. · ...
Fresno $67.16 - $100.75 (USD) Full time1 month ago
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Nurse Case Manager – Fresno to Bakersfield, CA · $100K–$130K + Bonus | Flexible Monday–Friday Hours · Join a team that makes a real difference for individuals recovering from work-related injuries. As a Nurse Case Manager, you'll coordinate evaluations, screenings, and case manag ...
Fresno $100,000 - $130,000 (USD)1 week ago
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Foster Farms is always looking for talented individuals to join the Foster Farms Team. We offer the experience of a large organization, however operate like a family business. · Workers' Compensation case management and cost containment · Support FMLA and Return-to-Work Programs ...
Fresno, CA1 month ago
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Care Career is seeking a travel nurse RN Case Management for a travel nursing job in Fresno, California. · Job Description & Requirements · Specialty: · Case Management · Discipline: · RN · Start Date: · 03/23/2026 · Duration: · 6 weeks · 40 hours per week · Shift: · 8 hours, day ...
Fresno1 day ago
Remote - Appeal Management Nurse - Fresno - Mercy
Description
Find your calling at MercyThis position is designed to facilitate an effective process of the new care model; supporting quality patient care, safety and financial components; promoting integration of a seamless care model; collaborating to include coordination as evidenced by metrics, optimizing performance and adoption of best practices.
The Appeal Management Nurse will provide guidance, coaching, staff development and problem solving for Mercys clinical improvement and compliance initiatives.
Position Details:
Education:
Graduate of an accredited School of Nursing required
Experience:
2 years in acute care hospital setting required
Licensure:
Current license in the state of residence and/or employment required.
Preferred Qualifications:
Experience:
Care Management, Utilization Management, and/or Appeal Management experiences preferred
Other Skills, Knowledge, Abilities:
Preferred Education:
Bachelor of Science in Nursing.
Physical Requirements:
Why Mercy?From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.
Join a caring, collaborative team where your voice matters.At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion.
As we grow, you'll grow with us.
By applying, you consent to your information being transmitted to the Employer by SonicJobs.
See Mercy Terms & Conditions atand Privacy Policy atand SonicJobs Privacy Policy atand Terms of Use
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