Medicare Prior Authorization Nurse

About the RoleWe are seeking a highly experienced and skilled Director, Medicare & Medi-Cal Utilization Management to join our team at Blue Shield of California. This critical role will play a key part in the success of our Utilization Management department in achieving its goals and objectives.Key ResponsibilitiesDevelop and implement effective utilization...

About the RoleWe are seeking a highly experienced and skilled Director, Medicare & Medi-Cal Utilization Management to join our team at Blue Shield of California. This critical role will play a key part in delivering and collaborating on all aspects of utilization management and care coordination for our Medicare and Medi-Cal membership.Key...

About the RoleThe Director of Medicare and Medi-Cal Utilization Management will play a critical role in the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives.Key ResponsibilitiesDevelop and implement utilization management strategies to ensure timely and cost-effective care for patients.Lead...

About the RoleThe Medical Director, Utilization Management plays a critical role in ensuring the delivery of high-quality, cost-effective healthcare services to our members. As a key member of the Blue Shield of California Medical Management team, you will be responsible for reviewing and making determinations regarding member and provider requests for...

About the RoleWe are seeking a highly skilled Medical Director, Utilization Management to join our team at Blue Shield of California. As a key member of our Medical Management department, you will play a critical role in ensuring our members receive the right level of care, at the right time, and at the right cost.Key ResponsibilitiesReview and make...

Job SummaryWe are seeking a highly skilled Medical Director, Operations to join our team at Blue Shield of California. As a key member of our Medical Management department, you will play a critical role in ensuring our members receive the right level of care, at the right time, and at the right cost.Key ResponsibilitiesReview and make determinations...

Job DescriptionJob Title/Position: Nurse Care SpecialistReports To: Clinical Supervisor/Nursing SupervisorJOB DESCRIPTION SUMMARYThe nurse care specialist plans, organizes, and directs home care services, emphasizing community health education and experience. This professional builds from the resources of the community to plan and direct services to meet the...

About the RoleWe are seeking a highly skilled Medical Director, Utilization Management to join our team at Blue Shield of California. As a key member of our Medical Management department, you will play a critical role in ensuring our Medi-Cal members receive the right level of care, at the right time, and at the right cost.Key ResponsibilitiesReview and make...

About the RoleWe are seeking a highly skilled Medical Director to join our team at Blue Shield of California. As a key member of our Medical Management department, you will play a critical role in ensuring our members receive the right level of care, at the right time, and at the right cost.Key ResponsibilitiesDevelop and deploy medical management...

Job SummaryBlue Shield of California is seeking a skilled Senior Clinical Review Nurse to join our Commercial Post Service Review team. As a key member of our team, you will be responsible for clinically reviewing claims that are the result of either a preservice or claim denial.Key ResponsibilitiesPerform accurate and timely clinical review of post service...

Job SummaryWe are seeking a highly skilled Utilization Management Nurse to join our team at Blue Shield of California. As a key member of our Commercial Post Service Review team, you will play a critical role in ensuring the accuracy and timeliness of clinical reviews for the CalPERS population.Key ResponsibilitiesPerform thorough and timely clinical reviews...

Your RoleThe Commercial Post Service Review team at Blue Shield of California is responsible for clinically reviewing claims that are the result of either a preservice or claim denial. As a Senior Clinical Reviewer, you will report to the Manager, Post Service, and perform accurate and timely clinical review of post service claims for the CalPERS...

Job Title: Utilization Management Nurse, Senior CalPERSAt Blue Shield of California, we are committed to ensuring all Californians have access to high-quality healthcare at a sustainably affordable price. We are seeking a skilled Utilization Management Nurse, Senior CalPERS to join our team.About the RoleThe Commercial Post Service Review team is responsible...

Job Description:The Pharmacy Services team plays a vital role in providing exceptional customer service to external customers and internal team members. As a key member of this team, you will be responsible for resolving pharmacy benefit coverage issues, communicating drug formulary guidelines, and researching administrative review and consumer affairs...

Job Summary:The Pharmacy Services team at Talent Software Services is seeking a highly skilled and detail-oriented individual to join our team as a Pharmacy Services Coordinator. In this role, you will be responsible for providing efficient and accurate responses to external customers and internal team members, resolving outpatient pharmacy benefit coverage...

Your RoleThe Clinical Services team is a key component of Blue Shield of California's operations. As a Clinical Services Coordinator, you will be responsible for processing phone and faxed requests for Continuity of Care, Access to Care for both commercial and Medi-Cal membership. This role may also require Peer or Peer provider support and other duties...

Job Summary:The Pharmacy Services team at Talent Software Services is seeking a skilled professional to provide efficient and accurate responses to external customers and internal team members. As a Pharmacy Services Coordinator, you will play a critical role in resolving outpatient pharmacy benefit coverage issues, communicating drug formulary guidelines,...

Job Summary:The Pharmacy Services team at Talent Software Services is responsible for providing efficient and accurate responses to external customers and internal team members. The ideal candidate will be responsible for resolving outpatient pharmacy benefit coverage issues, communicating drug formulary guidelines, and researching administrative review and...

About the RoleThe Utilization Management Nurse, Senior will play a critical role in ensuring the quality and appropriateness of care for our members. As a key member of the Utilization Management team, you will be responsible for reviewing inpatient stays to determine medical necessity and level of care.Key ResponsibilitiesPerform prospective utilization...

Job Description:The Pharmacy Services team plays a vital role in providing exceptional support to our customers and internal stakeholders. As a key member of this team, you will be responsible for resolving complex pharmacy benefit coverage issues, communicating drug formulary guidelines, and providing accurate and efficient responses to customer...