Healthcare Utilization Specialist

Job Title: Healthcare Utilization Manager**Overview:** Blue Shield of California is seeking a highly skilled RN to join our Utilization Management team. As a Healthcare Utilization Manager, you will play a crucial role in ensuring timely and accurate prior authorization of designated healthcare services.Estimated Salary: $85,000 - $110,000 per...

About the RoleThis is a senior-level position in our Utilization Management team. The Utilization Management Nurse, Senior Specialist will play a critical role in ensuring accurate and timely prior authorization of designated healthcare services.Key ResponsibilitiesPerform prospective utilization reviews and first-level determination approvals for members...

Job DescriptionAt Blue Shield of California, we are seeking a highly skilled Care Coordination Specialist - Utilization Management to join our team.About the RoleThis is an exciting opportunity to work in a dynamic environment where you will play a critical role in ensuring that our members receive high-quality care while also promoting cost-effective...

CorVel Healthcare Corporation is seeking a skilled Utilization Review Specialist to join our team. As a key member of our healthcare services department, you will be responsible for conducting utilization reviews to ensure medical necessity and appropriateness of treatment plans.In this role, you will analyze clinical data, communicate with healthcare...

Job SummaryWe are seeking a Clinical Nurse Educator to manage clinical education for new hires and existing staff. The ideal candidate will have experience in Utilization Management, Health Insurance, and learning principles.

About the PositionThis Care Management Clinical Specialist role is responsible for ensuring that healthcare services are utilized effectively and efficiently. The successful candidate will have strong clinical judgment and detailed knowledge of benefit plans to complete review decisions.Key ResponsibilitiesReview and Approval: Perform prospective utilization...

Role OverviewThe Utilization Management team at Blue Shield of California plays a critical role in reviewing inpatient stays for our members, ensuring that nationally recognized levels of care are applied correctly. As a Utilization Management Nurse, Senior, you will report to the Utilization Management Nurse Manager and be responsible for reviewing clinical...

Job Description:We are seeking a seasoned professional to fill the role of Utilization Management Lead at Blue Shield of California. This position will be responsible for overseeing the Utilization Management Prior Authorization team, ensuring timely and accurate prior authorization of designated healthcare services.The ideal candidate will possess a...

Are you a skilled healthcare professional looking for a challenging and rewarding role in utilization management?About the RoleWe are seeking an experienced LVN-Utilization Management Specialist to join our team at Eisenhower Health, a leading medical facility in the Coachella Valley. As a key member of our case management team, you will play a critical role...

Overview of the RoleThe Blue Shield Clinical Service Coordinator Advanced will support clinical staff in day-to-day operations for Promise (Medi-Cal) and Commercial/Medicare lines of business. In this role, you will be responsible for timely and accurate processing of Treatment Authorization Requests.Your ResponsibilitiesWork in a production-based...

Job OverviewWilson Construction Co. is a leading provider of electric utility infrastructure solutions across the United States and beyond.Key ResponsibilitiesOversee environmental permitting and compliance efforts in northern California operations.Estimate environmental costs of projects, manage protection of environmental resources during construction, and...

About the RoleThe Utilization Management Nurse, Senior will be responsible for ensuring the accurate and timely prior authorization of designated healthcare services. This professional will report to the Manager, Utilization and Medical Review, and be responsible for performing first-level determination approvals for members using BSC evidence-based...

About the RoleAs Director, Commercial Utilization Management at Blue Shield of California, you will play a critical role in realizing the company's goals and objectives. This position requires a leader who can deliver and collaborate on all aspects of utilization management and care coordination for Commercial membership. The ideal candidate will provide...

Located in the heart of Southern California, Eisenhower Medical Center offers a unique opportunity for a skilled medical professional to join our team as a Utilization Management Specialist. In this role, you will utilize your clinical expertise to concurrently screen admission reviews and collaborate with Case Management to identify utilization issues. Your...

Company Overview">Blue Shield of CA is a leading health insurance organization dedicated to providing high-quality healthcare services to its members. Our mission is to improve the health and well-being of our community by delivering innovative and cost-effective solutions.Salary">The estimated salary for this role is $104,615, based on industry standards...

Job OverviewThe Clinical Review Specialist, Senior performs in-depth clinical analysis of outpatient claims to assess medical necessity and compliance with established standards. This role involves collaboration with medical directors to ensure adherence to evidence-based guidelines.Your Key ResponsibilitiesPerform retrospective utilization reviews and...

At Eisenhower Health, we strive to deliver high-quality, compassionate medical care. As a Clinical Utilization Management Specialist, you will play a crucial role in ensuring that our patients receive the best possible treatment.Job DescriptionOur ideal candidate will have three years of experience in LVN or Case Management and possess excellent...

Job Summary: We are looking for a Healthcare Integration Specialist to join our team. This individual will be responsible for designing, developing, and maintaining data systems to support our mission.Key Responsibilities:Collaborate with cross-functional teams to identify business needs and customer requirementsParticipate in the evaluation and selection of...

**Job Overview**Rite Aid seeks a highly skilled and dedicated Regional Pharmacist to join our team. This role is an excellent opportunity for individuals who are passionate about delivering exceptional patient care and making a positive impact on the healthcare landscape.The successful candidate will be responsible for assisting customers with their...

A Great Opportunity Awaits!Are you a leader looking to make a positive impact in healthcare management? We're seeking an experienced professional to join our team as a Manager, Utilization and Medical Review. In this role, you will be responsible for leading a high-functioning team, overseeing day-to-day operations, and participating in process improvement...