- UCLA Health (Los Angeles, CA)
- …is responsible for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review Nurse ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital...of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical necessity… more
- Humana (Sacramento, CA)
- …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization , preferably within a ... caring community and help us put health first** The UM Administration Coordinator provides clerical support for the department....the nursing team + Builds and pends authorizations for review + Responsible for inbound and outbound calls to… more
- Humana (Sacramento, CA)
- …utilizing electronic medical record and documentation programs + Experience with Utilization Review and/or Prior Authorization , preferably within a managed ... + Knowledge of Medical Terminology and/or ICD-10 codes + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care… more
- LA Care Health Plan (Los Angeles, CA)
- … requests within a healthcare environment and at least 6 months of experience in UM correspondence. for prior authorization requests. At least 3 months of ... related to team performance and program effectiveness. Preferred: Advanced skills in UM authorization management systems (ie, QNXT, Onbase, CCA), Microsoft… more
- Molina Healthcare (San Diego, CA)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination of ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
- Molina Healthcare (Long Beach, CA)
- …2 years health care experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
- Molina Healthcare (CA)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination of ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
- Molina Healthcare (San Diego, CA)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination of ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
- University of Southern California (Alhambra, CA)
- …major duties of the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate that the appropriate patient status is ... assigned upon admission and prior to discharge; InterQual or MCG reviews are completed...1. Demonstrates sound clinical knowledge base regarding CM standards, UM standards, clinical standards of care, NCQA requirements, CMS… more