Manager, Utilization and Medical Review
3 weeks ago
Your Role The Medical Care Solutions Post Service Clinical Review team is hiring an RN manager who will be responsible for leading the clinical team that reviews post service and provider appeal cases for Commercial, MediCare, and MediCal lines of business.. The RN manager will report to the Sr. RN Manager. In this role you will be responsible for inventory management, staffing, vendor oversight, transformation readiness, audit readiness, reporting, special projects, and compliance.Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking,buildingand sustaining high-performing teams, getting results the right way, and fostering continuous learning. Your Work In this role, you will: Establish operational objectives for department and/or functional areas and participate with managers and stakeholders to establish shared objectives Be responsible for functional area quality and compliance results.Prepare files for regulatory and internal audits. Participate in regulatory and internal audits when necessary Adhere to the team’s annual budget and participate in budget planning under the direction of the team’s Manager and Director Ensureall work-flowprocedures and guidelines are clearly documented, updated, and communicatedtimely to the team Interpret or initiate changes in guidelines/policies/procedures Develop and implement recommendations for improvement of quality and production Stay current on regulatory changes and industry requirements Responsible for reporting, analysis, and vendor oversight metrics Collaborate with internal business partners #J-18808-Ljbffr
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Manager, Utilization and Medical Review
2 weeks ago
California, United States Blue Shield Full timeYour Role The Medical Care Solutions Post Service Clinical Review team is hiring an RN manager who will be responsible for leading the clinical team that reviews post service and provider appeal cases for Commercial, MediCare, and MediCal lines of business.. The RN manager will report to the Sr. RN Manager. In this role you will be responsible for inventory...
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Contract Nurse RN Utilization Review
1 month ago
California, USA, United States Trusted Resource Associates (TRA) Full timeJob Title: Contract Nurse RN Utilization ReviewTrusted Resource Associates (TRA) is seeking a skilled Contract Nurse RN Utilization Review professional to join our team.Job DescriptionSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeksShift: 8 hours, daysEmployment Type: Local ContractThe RN Case Manager is responsible for facilitating care along a...
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Contract Nurse RN Utilization Review
6 days ago
California, USA, United States Trusted Resource Associates (TRA) Full timeJob Description & RequirementsTrusted Resource Associates (TRA) is seeking a skilled RN Utilization Review professional for a local contract nursing position in California.Specialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Local ContractAs a RN Utilization Review professional, you will be...
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Contract Nurse RN Utilization Review
1 month ago
California, USA, United States Trusted Resource Associates (TRA) Full timeJob SummaryTrusted Resource Associates (TRA) is seeking a skilled Contract Nurse RN Utilization Review professional to join our team on a local contract basis in Modesto, California.Job DescriptionSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Local ContractAs a Contract Nurse RN Utilization...
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Registered Nurse
4 weeks ago
Downey, California, Los Angeles County, CA, United States Incredible Health Full timeHospitals on Incredible Health are actively hiring and accepting applications in the Downey, CA area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift Job types...
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Registered Nurse
4 weeks ago
San Leandro, California, Alameda County, CA, United States Incredible Health Full timeHospitals on Incredible Health are actively hiring and accepting applications in the San Leandro, CA area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift, night shift,...
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Local Contract Nurse RN Utilization Review
4 days ago
California, USA, United States Trusted Resource Associates (TRA) Full timeJob Title: Local Contract Nurse RN Utilization ReviewTrusted Resource Associates (TRA) is seeking a skilled contract nurse RN to fill a Utilization Review position in a local contract nursing role.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Local ContractAs a...
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Neurologist Medical Review Specialist
4 weeks ago
Los Angeles, California, United States Concentra Career Choice Full timeJob SummaryWe are seeking a Board Certified Neurologist to join our medical review team as a 1099 independent contractor. This telecommute role offers flexibility and autonomy, allowing you to customize your schedule and caseload within a Monday - Friday work week and within business hours.ResponsibilitiesReview medical files and provide recommendations for...
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Physician Advisor
3 weeks ago
California, United States MLK Community Healthcare Full timeJob SummaryWe are seeking a highly skilled Physician Advisor to join our team at MLK Community Healthcare. As a Physician Advisor, you will play a critical role in ensuring the efficient and effective use of healthcare resources while maintaining high-quality patient care.Key ResponsibilitiesCollaborate with the Senior Director of Care Management to balance...
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Clinical Reviewer
1 week ago
California, USA, United States MedRisk Full timeJob Title: Nurse ReviewerMedRisk is seeking a skilled Nurse Reviewer to join our team in our utilization review program. As a Nurse Reviewer, you will play a critical role in promoting quality outcomes and enhancing the physical, psychosocial, and vocational health of individuals.Job Summary:The Nurse Reviewer will apply technical knowledge and experience to...
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Physician Reviewer
4 weeks ago
California, United States Dane Street, LLC Full timeDane Street, LLC is seeking Board Certified physicians to conduct Independent Medical Exams (IME) and Peer Reviews. This opportunity allows you to customize your schedule and caseload within a standard Monday - Friday work week while maintaining client-mandated turnaround times. Our reviewers are compensated on a per-case basis as 1099 independent...
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Inpatient Review Nurse
3 weeks ago
California, USA, United States Alignment Healthcare Full timeOverview of the Role:Alignment Healthcare is seeking a remote Inpatient Review Nurse to join the Utilization Management team. As an Inpatient Review Nurse, you will play a critical role in assisting patients through the continuum of care, collaborating with the patient's primary care physician, facility case manager, discharge planner, and employing...
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Physician Reviewer
2 days ago
California, United States Dane Street, LLC Full timeDane Street, LLC is seeking Board Certified physicians to conduct Independent Medical Exams (IME) and Peer Reviews. This opportunity allows you to customize your schedule and caseload within a standard Monday - Friday work week while maintaining client-mandated turnaround times. Our reviewers are compensated on a per-case basis as a 1099 independent...
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Physician Reviewer
5 days ago
California, United States Dane Street, LLC Full timePhysician Reviewer OpportunityDane Street, LLC is seeking Board Certified physicians to conduct Independent Medical Exams (IME) and Peer Reviews. This opportunity allows you to customize your schedule and caseload within a standard Monday - Friday work week while maintaining client-mandated turnaround times.Physician Specialties: Internal Medicine, Family...
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Utility Locator
1 month ago
California, United States TEKsystems Full timeDescription: • Conducting site surveys to identify and mark the location of underground utilities. • Using a variety of tools and equipment, such as ground-penetrating radar and electromagnetic locators, to detect and map underground utilities. • Collaborating with construction crews, engineers, and project managers to ensure accurate utility...
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Senior Credit Reviewer
4 weeks ago
Pasadena, California, United States East West Bank Full timeJob Title: Senior Credit ReviewerEast West Bank is seeking a highly skilled Senior Credit Reviewer to join our team. As a Senior Credit Reviewer, you will be responsible for conducting loan and credit file reviews to assess the adequacy and effectiveness of our credit risk management policies and processes.Key Responsibilities:Conduct thorough loan and...
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Utility Locator
1 month ago
California, United States TEKsystems Full timeDescription: TEKsystems is in need of a Utility Locator for our client in the California, MD market! This client is expanding their locating services department, and they need a highly skilled professional to join the team as a utility locator specializing in water, sewer, and fiber. Our locating department plays a pivotal role in ensuring project...
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Utility Locator
1 month ago
California, United States TEKsystems Full timeDescription: Our client is looking for an experienced Utility Locator. This Locator would be identifying utilities such as electrical cables, water mains, and sewer lines, ensuring comprehensive coverage and adherence to safety standards. Responsibilities: • Conducting site surveys to identify and mark the location of underground utilities. •...
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Water Utilities Project Manager
4 weeks ago
California, United States Fluor Corp Full timeJob Title: Water Utilities Project ManagerFluor and its joint-venture partner AECOM have been awarded a four-year program delivery support services contract for the California High-Speed Rail program by the California High-Speed Rail Authority.The system will connect the 500-mile stretch between the Los Angeles region with the San Francisco Bay Area, with up...
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Utility Locator
3 weeks ago
California, United States TEKsystems Full timeDescription: is a dynamic cooperative based in Salisbury, MD. Our mission is to transform Maryland's digital landscape by ensuring accessible and reliable broadband connectivity. We unite businesses, communities, and service providers to advance and strengthen broadband infrastructure throughout the state, aiming to bridge the digital divide, fuel local...