- Centene Corporation (San Diego, CA)
- …experience with Utilization Review or Utilization Management related to Behavioral Health case is preferred + Clinical knowledge and ability to review and/or ... (CST)** **Remote - CA or Remote - TX** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and… more
- Dignity Health (Rancho Cordova, CA)
- …pend letter appropriately when facts are needed to reach determination. - Preps case thoroughly, concisely and clearly for physician review . Researches EMR, ... the Greater Sacramento, CA region.** **Position Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing utilization...medical policy and past history of member to detail case cleanly for MD in 95% of the cases.… more
- UCLA Health (Los Angeles, CA)
- …as a liaison between clinicians, internal departments, and members. + Documents all review findings and decisions in the case management system and supports ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring...to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established… more
- Prime Healthcare (Ontario, CA)
- …follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review ... members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization ...review tech essentially works to coordinate the utilization review and appeals process as part of the denial… more
- Prime Healthcare (Inglewood, CA)
- …communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use ... in a Health and Human Services field is highly preferred. 2. Utilization Review / Case Management experience is highly preferred. 3. 1+ year of clinical experience… more
- Robert Half Legal (Oakland, CA)
- Description We are seeking a California-barred Document Review Attorney for a fully remote opportunity supporting litigation and compliance projects. This role is ... East Bay area for occasional in-person meetings or onboarding. Responsibilities + Review and analyze large volumes of documents for relevance, privilege, and… more
- Prime Healthcare (Ontario, CA)
- …communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use ... and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Treatment Team meetings. Serves as on-going educator to all… more
- Deloitte (Los Angeles, CA)
- …facts patterns and laws, regulations, cases and administrative guidance. + Comprehensive review of information to understand a Client's business and its tax returns. ... up of multiple tax service offerings including Strategic Tax Review , Inventory Tax Services, and Meals & Entertainment ...are dependent on the facts and circumstances of each case . A reasonable estimate of the current range is… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: LVN/LPT $31.50-37.50 Per Hour RN/LCSW/LMFT/LPCC ... $54.00-64.00 Per Hour REPORTS TO: Director of Utilization Review DESCRIPTION OF POSITION: Work as member of multi-disciplinary treatment team reviewing patient care… more
- Emanate Health (Covina, CA)
- …requested services using clinical judgment and refer to Medical Directors for review depending on case findings. **Job Requirements** **M** **inimum Education ... the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying… more