Utilization review nurse jobs in Menifee, CA

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care.. Gather and develop statistical and narrative information to report on utilization, non certified days..

Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job.. Job Description & Requirements Specialty. Utilization Review Discipline. RN Duration. 15 weeks 36 hours..

Your Role Reporting to the Sr. Director, Utilization Management, the role of the Director, Commercial.. Manages and monitors prior authorization and concurrent review to ensure that the patient is getting the..

SCOPE OF ROLE The role of the UM Nurse is to promote quality, cost effective outcomes for a population.. or concurrent medical necessity reviews for an assigned panel of members Review cases for medical..

We are seeking a detail oriented QA QC Technical Reviewer for electrical systems to perform technical.. Duties. Performs technical review of proposed electrical plans and specifications submitted by District..

Join a Prestigious San Francisco Law Firm as a Document Review Attorney for High Profile Litigation.. Bar Admission. Must be licensed to practice law in California. Document Review Experience. Previous..

hours per week Experience. Minimum 2 years License. Active RN License (CA) Certifications. N A Must Have. Strong Utilization Review and InterQual experience. Acute Care hospital experience..

WHAT YOU'LL BE RESPONSIBLE FOR Perform concurrent or post service (retrospective) review of acute in.. Utilization Management, and or Case Management principles and practicesMedi Cal and related policies and..

Description Title. RN, Coordinator Quality Peer Review Location. Long Beach Department. Q uality.. Education Licensure Certification. Current Registered Nurse (RN) license in state of California required..

Coordinate the Medical, Legal, and Regulatory (MLR) Review process for all medical and commercial.. Maintain comprehensive records of MLR review activities, approvals, and changes to ensure proper..

Utilization Management is responsible to collaborate with healthcare providers and members to promote.. Licensed NursePlease be advised that Elevance Health only accepts resumes for compensation from agencies..

Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively,. Humana ) offers competitive benefits that support whole person well being. Associate benefits ar..

Job DescriptionA bit about this role. This position interacts with utilization management, clinical.. clinical reviews (i.e., part A, B, appeals, quality of care) and conduct peer to peer discussions..

RN Case Manager with experience as follows. Must have strong Utilization Review and InterQual experience REQUIRED! Conducting patient initial assessments Acute Care hospital experience EPIC EMR..

The Director, eData Managed Review provides administrative oversight to assigned eData managed review.. ensuring managed review legal staff meet all administrative requirements for managed reviews, and..

Forbes Best in State EmployerBill Review Trainer. Hearing SpecialistPRIMARY PURPOSE. To develop and.. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Reviews upcoming hearings and prepares necessary documentation..

JOB SUMMARY The Transfer DRG Revenue Review Specialist performs work to capture lost revenue for.. The company has reviewed this job description to ensure that the essential functions and basic duties..

Acentra seeks a Utilization Clinical Reviewer to join our growing team. Job Summary As a Utilization.. This Full Time Clinical Reviewer Position is a Remote, work from home position based in the state of..

weeks 40 hours per week Shift. 8 hours, days Employment Type. Travel Nurse First Job ID. 52690824.. About Nurse First Nurse First Travel Agency is committed to giving travel nurses the best experience..