- The County of Los Angeles (Los Angeles, CA)
- …staff training is needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to ... year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS.**...provided to patients are appropriate and covered by the insurance payer. They are responsible for ensuring that patient… more
- Prime Healthcare (Ontario, CA)
- …actively seeking new members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization review and ... appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry, mailing/faxing appeals… more
- Prime Healthcare (Ontario, CA)
- …actively seeking new members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization review and ... calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals.… more
- Alameda Health System (Oakland, CA)
- …outpatient). 3. Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity criteria. ... of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating in appropriate… more
- Centene Corporation (Sacramento, CA)
- …with quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against guidelines and ... of care issues, and if identified, refer to the Medical Director or provider for review and...offers a comprehensive benefits package including: competitive pay, health insurance , 401K and stock purchase plans, tuition reimbursement, paid… more
- Centene Corporation (Sacramento, CA)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... current CA license.** **Must have** **2-4 years related** **experience in UM-Concurrent Review . 2+ years of acute care experience required. 10% Travel required.**… more
- TEKsystems (Westlake Village, CA)
- Now Hiring: Loan Review Specialist - Pre-Purchase Review (Residential Mortgage) Hybrid | Remote Fridays | Full-Time | Competitive Pay + Growth Opportunity Are ... elevate your career into underwriting? We're seeking a Loan Review Specialist to join a high-performing team focused on...for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and… more
- TEKsystems (Westlake Village, CA)
- Description The Loan review specialist in pre-purchase review is responsible for the pre-purchase review of Conventional, Non-Conforming, FHA, and VA loan ... documentation. * Be an integral part of the pre-purchase review of Conventional, Non-Conforming, FHA, and VA loans files...for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and… more
- TEKsystems (Westlake Village, CA)
- Description The Loan review specialist in pre-purchase review is responsible for the pre-purchase review of Conventional, Non-Conforming, FHA, and VA loan ... documentation. + Be an integral part of the pre-purchase review of Conventional, Non-Conforming, FHA, and VA loans files...for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and… more
- Providence (Napa, CA)
- …Manager RN - Utilization Review unit at Providence Queen of the Valley Medical Center in Napa, CA. This position is Full-Time and will work 8-hour Day shifts. ... including a retirement 401(k) Savings Plan with employer matching, health care benefits ( medical , dental, vision), life insurance , disability insurance , time… more