- TEKsystems (Canoga Park, CA)
- …experienced RN or LVN with an active license to join our team as a Utilization Review Nurse. In this role, you will conduct retrospective reviews of inpatient and ... within a managed care environment. Key Responsibilities + Perform comprehensive utilization reviews for inpatient and outpatient claims. + Prepare medical records… more
- TEKsystems (Canoga Park, CA)
- Position: Utilization Review Nurse Work Enviroment: Hybrid work schedule Schedule: Full time position, Flexible start time of 7-8 am, 5 days x 8hrs , no weekends, ... processing in a managed care environment. Key Responsibilities: + Perform detailed utilization reviews for inpatient and outpatient claims. + Prepare medical records… more
- TEKsystems (Canoga Park, CA)
- …Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims processes. ... + Active LVN or RN license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with HMO/Medicare claims, audits, and denials +… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Quality Reporting and Auditing Specialist I Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, ... support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Quality Reporting and Auditing Specialist I is responsible… more
- Deloitte (Los Angeles, CA)
- …registered nurse, physician, physician assistant, case manager, clinical documentation specialist , utilization review, informatics RN, Quality, DRG Validation ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk...financial concerns and other business controversy. A Clinical Documentation Specialist (CDS) works to ensure accuracy and completeness of… more
- Datavant (Sacramento, CA)
- …realize our bold vision for healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review ... of admissions for medical necessity and necessity of continued stay in the inpatient patient care setting and/or discharge to an alternative level of care. Using nationally recognized medical necessity criteria and standards of care, along with clinical… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** The Sr Specialist Integrated Care Management is a key member of the Integrated Care Management ... care teams, site and system leadership, and senior leaders, the Sr Specialist provides expert consultation on complex and escalated cases. The role also… more
- Battelle Memorial Institute (San Diego, CA)
- …business line is seeking a highly motivated, full-time **Senior Strength and Conditioning Specialist ** to join our team in support of our government customer, US ... support for those who serve. As a Senior Strength and Conditioning Specialist , you will contribute to impactful research and analytics that drive evidence-based… more
- J&J Family of Companies (San Francisco, CA)
- …appropriate utilization of JJIM access and fulfilment resources. The APP- Specialist will compliantly collaborate with other field team members in delivering all ... Innovative Medicine (JJIM) is recruiting for an **Advanced Practice Provider Specialist , Gastroenterology** , in the Northern California territory. Our expertise in… more
- Battelle Memorial Institute (San Diego, CA)
- …(HRA) business line is seeking a highly motivated, full-time **Strength and Conditioning Specialist ** to join our team in support of our government customer, US ... comprehensive support for those who serve. As a Strength and Conditioning Specialist , you will contribute to impactful research and analytics that drive… more