Utilization Management Nurse, Senior

Your RoleThe Utilization Management team at Blue Shield of CA reviews inpatient stays for our members under nationally recognized levels of care guidelines.The Senior Utilization Management Nurse will report to the Utilization Management Nurse Manager.In this role, you will be assigned a list of inpatient facilities and review clinical information provided...

Your Role The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Utilization Management Nurse, Senior will report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing medical...

Your Role The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Utilization Management Nurse, Senior will report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing medical...

Your Role The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Utilization Management Nurse, Senior will report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing medical...

Your Role The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Utilization Management Nurse, Senior will report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing medical...

Your Role The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Utilization Management Nurse, Senior will report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing medical...

Your Role The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Utilization Management Nurse, Senior will report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing medical...

Job SummaryWe are seeking a highly skilled Senior Utilization Management Nurse to join our team at Blue Shield of California. In this role, you will be responsible for reviewing medical documents and applying clinical criteria to establish the most appropriate level of care. You will also be reviewing hospital itemized bills for a comprehensive line-by-line...

Job SummaryThe Senior Utilization Management Nurse will be responsible for performing first-level determination approvals for members using BSC evidenced-based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business such as Medicare. This role requires a strong clinical judgment and...

Job SummaryThe Senior Utilization Management Nurse will be responsible for reviewing medical documents and applying clinical criteria to establish the most appropriate level of care. This role requires a strong understanding of medical necessity, coding accuracy, and contract compliance.Key ResponsibilitiesPerform retrospective utilization reviews and...

Your Role The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Utilization Management Nurse, Senior will report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing medical...

Your Role The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events . The Utilization Management Nurse, Senior will report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing...

Your Role The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Utilization Management Nurse, Senior will report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing medical...

Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including...

Your Role The Medical Care Solutions education team is responsible for all clinical education for all departments within Medical Care Solutions as well as some Health Solutions teams. This includes Utilization Management, Care Management, Post Service, and Appeals. This clinical educator role will be responsible for Utilization Management for all lines of...

Your Role Work schedule is Mon- Fri 10am-7pm The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Triage...

Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including...

Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager  will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures...

Job Summary: We are seeking a highly skilled Senior Estimator to join our team at Your Hiring Coaches. As a Senior Estimator, you will be responsible for estimating wet utility projects from inception to completion, including transitioning a winning bid to operations. You will work closely with our team to ensure accurate and timely estimates, and will be...

Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Regional Registered Nurse Case Manager will report...