- Prime Healthcare (Garden Grove, CA)
- …of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Works with health information management staff, coding ... staff, physicians, financial services, onsite and remote utilization review teams with regards to admission criteria, medical necessity, payment denials, and… more
- UMB Bank (Sacramento, CA)
- …under normal and stressed scenarios. Within Credit Administration, the **Appraisal Review ** team supports Commercial, Small Business and Consumer Lending. As a ... Senior Commercial Review Appraiser, you will ensure compliance with the valuation...validations of commercial real estate properties. + You will review and validate appraisals of complex and higher-risk commercial… more
- Harris & Associates (Irvine, CA)
- …Senior Project Manager to help lead, market and expand our Cost Reimbursement Review team. The ideal candidate will have strong project management skills, experience ... schedules, and monitoring project budgets. + Leads cost reimbursement review projects including change order reviews, preparation of cost...reports, memos, etc.) and advanced Excel, to prepare and review work products. + Ability to manage and lead… more
- Centene Corporation (Sacramento, CA)
- …health clinicians preferred. Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required. Knowledge of ABA services ... and BH utilization review process required. Experience working with providers and healthcare...required. Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services… more
- Emanate Health (Covina, CA)
- …and the #19 ranked company in the country. **Job 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
- Sharp HealthCare (San Diego, CA)
- …achieve selected utilization/cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations for updating current polices to ... EHB's are updated and implemented into policies. + Participates in the retrospective review and analysis of Plan performance from summary data of paid claims,… more
- Prime Healthcare (Ontario, CA)
- …clinical and cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the medical necessity, intensity of service ... for a Health Plan. + At least 3 years of experience in utilization review , referrals, authorizations, denials and appeals. + Current BCLS (AHA) certificate upon hire… more
- Sedgwick (Sacramento, CA)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical and ... line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. **Skills &… more
- Northrop Grumman (Los Angeles, CA)
- …history, they're making history. **Northrop Grumman Defense System's** is seeking a **Design Review Engineer Level 3/4** . This position will be located at our ... and it's associated standards and site requirements manuals as part of document review process in order to satisfy program and customer need. + Develop processes… 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