Utilization Management Clinical Review Nurse, Lead

Job OverviewThe Utilization Management Nurse, Senior role at Blue Shield of California is a critical position that requires a seasoned professional with expertise in clinical review and prior authorization. This individual will be responsible for conducting thorough assessments of inpatient admissions and length of stay to ensure compliance with regulations...

Company Overview">Blue Shield of California is a leading health insurance company dedicated to providing high-quality healthcare services to its members. The organization values innovation, excellence, and teamwork in achieving its goals.Job Summary">We are seeking an experienced Healthcare Executive Director for Utilization Management to lead our team in...

**Overview**At Blue Shield of California, we are committed to delivering exceptional healthcare services. We are seeking a highly skilled Medical Director, Utilization Management Specialist to join our team.**Salary Range**The estimated salary range for this role is $165,990.00 - $248,930.00 per year, based on experience and location.**Job Description**As a...

Your RoleAs a Senior Manager of Utilization and Care Coordination at Blue Shield of California, you will play a critical role in realizing the company's goals and objectives. This position is key to the success of the Utilization Management department and requires an individual who can provide direction and leadership in compliance with regulatory...

Job SummaryBlue Shield of California is seeking a highly skilled and experienced Strategic Director of Healthcare Utilization to lead our Commercial Utilization Management team. In this critical role, you will play a key part in realizing the department's goals and objectives, while ensuring that patients receive timely and cost-effective care.Key...

Job OverviewIn this role, you will be responsible for reviewing inpatient stays and ensuring medical necessity in compliance with state and federal regulations. This position involves conducting clinical reviews, discharge planning, and presenting cases to the Medical Director.We are seeking a Senior Utilization Management Nurse who is dedicated to...

Job Summary">This role is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives. As a Senior Manager, Clinical Operations and Strategy, you will play a key role as part of the Utilization Management team in delivering and collaborating on all aspects of utilization management and...

Job OverviewWe are seeking an experienced Utilization Management Executive to lead our efforts in managing Medicare and Medi-Cal utilization. This role plays a vital part in ensuring the success of Blue Shield of California.The ideal candidate will have a proven track record in driving organizational change management, with excellent relationship and...

About the RoleAs a Senior Medical Director, Behavioral Health at Blue Shield of California, you will lead our clinical strategy in behavioral health services. You will oversee the clinical behavioral health program and provide leadership to the behavioral health medical director team.Your Key ResponsibilitiesChair the behavioral health committee and...

About the RoleWe are seeking a seasoned healthcare professional to lead our Utilization Management team at Blue Shield of California. As Senior Healthcare Manager, Utilization Excellence, you will play a critical role in ensuring our members receive timely and cost-effective care.Key ResponsibilitiesStrategic Leadership: Develop and implement utilization...

About the RoleWe are seeking a skilled Utilization Management Nurse, Senior to join our team at Blue Shield of California. In this role, you will conduct clinical reviews to assess the medical necessity of inpatient admissions and length of stay, ensuring compliance with regulations.

Overview: Blue Shield of California seeks a skilled Utilization Management Nurse, Senior to review inpatient stays and ensure medical necessity compliance with state and federal regulations.About the Role:In this critical position, you will conduct clinical reviews, discharge planning, and present cases to our Medical Director. You will work closely with...

Job OverviewWe are seeking a Senior Healthcare Utilization Specialist to join our team at Blue Shield of California.Job SummaryThe Senior Healthcare Utilization Specialist is responsible for reviewing inpatient stays and determining medical necessity in compliance with state and federal regulations. This role involves conducting clinical reviews, discharge...

Job Summary:We are seeking a skilled Healthcare Utilization Specialist to join our team at Blue Shield of California. In this role, you will be responsible for conducting clinical reviews, discharge planning, and presenting cases to the Medical Director.About Us:Blue Shield of California is a leading health insurance provider committed to delivering...

Job OverviewThe Clinical Care Specialist, Senior at Blue Shield of California plays a vital role in reviewing inpatient stays for our members, ensuring that care meets nationally recognized levels of necessity. This position reports to the Utilization Management Nurse Manager and involves clinical information review, discharge planning, and transfers as...

About the RoleWe are seeking a highly skilled and experienced Senior Medical Director, Behavioral Health to join our team at Blue Shield of California. As a key member of our Medical Management team, you will play a vital role in ensuring that we are on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based...

Company Overview:Inland Empire Health Plan (IEHP) is a leading healthcare organization dedicated to healing and inspiring the human spirit. As a dynamic and innovative team, we strive to provide exceptional care and services to our members.Salary: $80,059.20 - $106,059.20 per yearJob Description:We are seeking an experienced Senior Special Investigations...

About Blue Shield of CaliforniaBlue Shield of California is a leading health plan in the state, dedicated to providing high-quality healthcare services to its members.Job SummaryThe Senior Clinical Care Manager will play a crucial role in our Federal Employee Program (FEP) team, responsible for integrated case management and disease management activities....

Job SummaryThe Medical Director of Behavioral Health plays a pivotal role in ensuring the quality and efficiency of mental health services. As a key member of our team, you will oversee pre- and post-service utilization reviews, collaborate with healthcare providers to deliver high-quality care, and train care management staff to ensure compliance with...

About Blue Shield of CaliforniaWe are a leading healthcare provider in California, committed to delivering high-quality medical services to our members.Job Title: Medical Management CoordinatorJob Type: Full-timeSalary Range: $20.47 - $28.66 per hourAbout the RoleThe Clinical Services Coordinator (CSC), Intermediate will support clinical staff in their...