• Medical Claim Review…

    Molina Healthcare (Long Beach, CA)
    …clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License, Certification, Association** Active, ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...of proactive approaches to improve and standardize overall retrospective claims review . * Ensures core system is… more
    Molina Healthcare (09/17/25)
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  • LVN - Quality Assurance/Utilization…

    Emanate Health (Covina, CA)
    …decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete ... States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity… more
    Emanate Health (09/06/25)
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  • Telephonic Nurse Case Manager

    ICW Group (San Diego, CA)
    …required; ensures quality and appropriate service delivery. + Communicates effectively with medical providers, the assigned claims examiner, injured worker and ... clinical assessment and evaluate needs for treatment in worker's compensation claims . The Telephonic Nurse Case Manager will negotiate and coordinate appropriate… more
    ICW Group (09/17/25)
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