- Molina Healthcare (San Diego, CA)
- …JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- Molina Healthcare (San Diego, CA)
- California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_3-12 NIGHT SHIFT 7:30PM - 08:30AM PACIFIC HOURS NON EXEMPT, 3 days a week will ... **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Dignity Health (Rancho Cordova, CA)
- …from home** **within driving distance of Sacramento, CA** **.** As a Utilization Review (UR) LVN, you will use clinical judgement in providing utilization management ... position may be assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review . Responsibilities may include: - Conducts… more
- Molina Healthcare (Long Beach, CA)
- …JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... health care experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant… more
- Molina Healthcare (CA)
- …JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- Emanate Health (Covina, CA)
- …the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and… more
- Prime Healthcare (Lynwood, CA)
- …effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236088/rn-case-manager utilization- review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySt. Francis Medical… more
- Leprino Foods (Lemoore, CA)
- At Leprino Foods, starting compensation for this role is QE Product Review Clerk V Rate$23.78 - $27.35 (Break in rates and $0.75 cents differential pay from 6PM - ... 5:59AM applies). Summary Description: The QE Review Clerk V is responsible for shipping all Corporate and Customer samples and supporting sample pulling duties. QE… more
- Sutter Health (Berkeley, CA)
- …utilization of physician, nursing, and ancillary services. Responsible for concurrent review on specific patients. Develops, coordinates and monitors systems for the ... with hospital administration, medical staff, patient registration and representatives of review organizations and others to ensure effective utilization of services… more
- CVS Health (Sacramento, CA)
- …research, analyze and document analytic leads or referrals to send for investigative review . + Review company clinical and payment policies to determine the ... impact of the scheme on Aetna business. + Keep current with new and emerging fraud, waste, and abuse schemes and trends through training sessions and industry resources. + Communicate with colleagues, verbally and in writing, findings related to data analysis… more