Appeals & Quality Review Manager - San Francisco

The Appeals & Quality Review Manager provides leadership and oversight of SFHP's quality review functions, ensuring timely and compliant resolution of clinical grievances, appeals, · PQIs. · ...

+ Job summary: Reporting to the Sr Medical Director the Nurse Manager Quality Review provides leadership and oversight of SFHP's quality review functions ensuring timely and compliant resolution of clinical grievances appeals potential quality issues PQIs provider dispute resolut ...

We are seeking an energetic, analytic, and intellectually curious Independent Assessment & Review Manager to join our Fraud Risk team. You will conduct assessments of the fraud program design and operational effectiveness. · Develop fraud 1st line program assessment methodology a ...

The SoFi team is looking for an energetic and analytic Independent Assessment & Review Manager to join their Fraud Risk team. · ...

The Appeals & Quality Review Nurse Manager provides leadership and oversight of SFHP's quality review functions. · Provides subject matter expertise and high-level oversight of clinical grievances and appeals. · Apply clinical judgment to complex and high-value cases, ensuring ap ...

The Nurse Manager provides leadership and oversight of SFHP's quality review functions. They apply clinical judgment to complex cases guiding resolution strategies that balance regulatory requirements organizational standards member needs. · BSN required. · 2 to 4 years of relate ...

Manages 24-hour departments providing patient care services. Ensures staff provide high quality, accessible, cost effective care, and patient focused services to members across the continuum, which comply with local, state, and federal requirements. · ...

Manages 24-hour departments providing patient care services. Ensures staff provide high quality, accessible, cost effective care, and patient focused services to members across the continuum, which comply with local, state, and federal requirements. · ...

We have an exciting opportunity for a Senior Manager of Managed Review Workflow and Analytics to join our team! · This role will lead the design and implementation of AI-enabled document review workflows that support our litigation services. · ...

The Contra Costa Health Department is seeking to fill two (2) Utilization Review Manager positions in Contra Costa Health Plan, · in the Case Management Department located in Martinez, CA.We are seeking a strategic, · experienced, · and collaborative Utilization Review Manager to ...

Assess patient needs and develop individualized care plans. Review treatment plans, hospital stays, and services for medical necessity. · Collaborate with providers, interdisciplinary teams. · ...

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Meta is seeking a Program Manager to support our people data assessment and review program involving HR, employment and data privacy risks related to People Data at Meta. · Experience designing and implementing from zero to one risk assessment programs that impact security, priva ...

LanceSoft requires a travel nurse RN Case Manager for 13 weeks in Greenbrae, California. The job involves conducting patient initial assessments and utilizing InterQual experience. · Conducting patient initial assessmentsUtilizing InterQual experienceEPIC EMR documentation experi ...

LanceSoft is seeking a travel nurse RN Case Management for a travel nursing job in Greenbrae, California. · Job Description & Requirements · Specialty: · Case Management · Discipline: · RN · Start Date: · 03/17/2026 · Duration: · 13 weeks · 40 hours per week · Shift: · 8 hours, d ...

LanceSoft is seeking a travel nurse RN Case Management for a travel nursing job in Greenbrae, California. · ...

LanceSoft is seeking a travel nurse RN Case Management for a travel nursing job in Greenbrae, California. · Job Description & Requirements · Specialty: Case Management · Discipline: RN · Start Date: 03/02/2026 · Duration: 13 weeks · 40 hours per week · Shift: 8 hours, days · Empl ...

+ MedPro Healthcare Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Greenbrae California. · + The role of the case management nurse (RN) is to coordinate continuity of care for patients often as a liaison between the patient's family and healthc ...

We are seeking a travel nurse RN Case Management for a travel nursing job in Greenbrae, · California.LanceSoft is a Certified MBE and Woman-Owned organization offering competitive · compensation, · benefits, · and career growth opportunities. · ...

Synergy Medical Staffing is seeking a travel nurse for a case management position in Greenbrae, California. · RN - Case Manager required. · ...