Clinical Nurse Specialist, Community Supports

2 weeks ago


Alameda, California, United States Allameda Alliance for Health Full time
Job Summary

We are seeking a skilled Clinical Nurse Specialist to join our team at Allameda Alliance for Health. As a key member of our Community Supports team, you will play a critical role in evaluating the clinical presentation of members in need of our services.

Key Responsibilities
  • Review prospective, inpatient, or retrospective medical records to determine medical necessity
  • Consult with the Alliance Medical Director to validate patient acuity and plan of care as needed
  • Extrapolate and summarize medical information for Medical Director, consultants, or other external review entities
  • Apply clinical medical necessity guidelines, policy, and procedures, and EOC benefit guidelines
  • Prepare recommendations to approve or deny services and forward recommendations for denial of payment to the Medical Director for review
Requirements

To be successful in this role, you will need to have a strong clinical background, excellent communication skills, and the ability to work effectively in a team environment.

We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.



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