Clinical Review Specialist

About the Role:We are seeking a skilled Clinical Utilization Review Specialist to join our team. As a key member of our Revenue Cycle department, you will play a vital role in ensuring the accurate and efficient management of patient care.Key Responsibilities:Conduct thorough clinical reviews of medical records to ensure compliance with health plans and...

About the RoleWe are seeking a highly skilled Care Management Specialist to join our team at Blue Shield of California. As a Care Management Specialist, you will play a critical role in providing identification, referrals, and care management for all Medi-Cal members under 21 years old.Your ResponsibilitiesPerform clinical review, assessment, and evaluation...

Job Summary: We are seeking an experienced Clinical Case Manager Consultant to join our team at Blue Shield of California. The successful candidate will have a strong background in clinical review, case management, and care coordination. This is a challenging role that requires a high level of expertise and attention to detail.">About the Role:">">Conduct...

Company OverviewMercy Medical Group (MMG) is a dynamic, growing organization with a long-standing history of providing exceptional medical care in the Sacramento area. MMG is a large multi-specialty medical group comprising over 500 providers, including primary care physicians, specialists in more than 30 medical and surgical specialties, physician...

Nurse Reviewer I (US)Role OverviewWe are seeking a skilled clinical reviewer to join Elevance Health in conducting preauthorization and appropriateness of treatment reviews for diagnostic imaging services.About the RoleCollaborate with healthcare providers and members to promote the most appropriate, highest quality and effective use of diagnostic...

About the RoleGotham Enterprises Ltd is hiring a Full-Time Licensed Clinical Social Worker (LCSW) to provide compassionate care to patients in long-term care facilities.This position offers a competitive salary of $110,000-$130,000 per year, comprehensive medical, dental, and vision coverage, and a 401(k) plan with employer match.As a Licensed Clinical...

Cerulean Consulting Inc.We are a forward-thinking business consulting and sales firm thriving in the local area, renowned for our innovative marketing strategies and dominating sales tactics. Our reputable clients are expanding, and we are seeking entry-level candidates to join our marketing and sales team as an Account Management Specialist. Our primary...

Home Care Specialist Wanted!Estimated Annual Salary: $50,000 - $70,000Senior Helpers - Cameron Park seeks a compassionate and skilled home care specialist to provide personalized care and support to our clients. As a home care specialist, you will work independently with clients, developing customized care plans that address their unique needs and...

Job Summary:We are seeking a highly skilled Addiction Counselor Specialist to join our team at First Steps Recovery. As an essential member of our staff, you will play a vital role in providing individualized counseling and clinical services to clients struggling with addiction.This is a challenging yet rewarding position that requires strong communication...

Job OverviewMarshall Medical Center is seeking a highly motivated Patient Flow Specialist to join our team. In this role, you will play a critical part in ensuring the smooth operation of our outpatient clinics. You will work closely with medical caregivers to coordinate patient flow, enable physicians to provide high-quality care, and contribute to the...

About UsAt Education Enrichment Services, we strive to provide exceptional support to individuals with various behavioral needs.We are seeking a qualified Behavior Support Specialist to join our team in Sacramento, Placer, and El Dorado County. As a Behavior Support Specialist, you will play a vital role in implementing behavioral techniques and promoting...

Compensation Package">We offer a competitive salary range of $45,000 - $65,000 per year, based on experience and qualifications, as well as a comprehensive benefits package, including medical, dental, and vision insurance, paid time off, and tuition reimbursement.

**About This Role**We are seeking a highly skilled and experienced Senior Care Manager to join our team at Blue Shield of California. In this role, you will have the opportunity to make a meaningful difference in the lives of our members by providing high-quality care and wellness services.Key Accountabilities:You will be responsible for designing and...

Job Title: Clinical Utilization SpecialistAbout Emonics LLC:Emonics LLC is a reputable healthcare organization that offers outpatient services. Our team consists of experienced professionals dedicated to delivering high-quality care.Salary:$85,000 - $110,000 per year (based on experience)About the Job:We are seeking a skilled Registered Nurse for our...

Job OverviewWe are a respected orthodontic clinic in El Dorado, Arkansas seeking a positive, upbeat orthodontist who loves leading a team while changing the lives of our patients. Our well-established practice offers an established patient base and we provide excellent support so that you can focus on what you love and leave the administration to us.About...

At Blue Shield of California, we are dedicated to providing quality healthcare services to our members. As a Healthcare Consultant - Case Management, you will play a critical role in ensuring that our members receive the best possible care.About the RoleIn this position, you will be responsible for managing member needs for specific clinical programs and...

Key ResponsibilitiesResponsible for all planning surrounding daily, month-end and annual production runs.Handle higher-level client issues, conversations and partner concerns.Plan and execute strategic business reviews with strategic conversations emphasizing contract acumen.

Job Title: JD Edwards EnterpriseOne Solutions SpecialistLocation: RemoteJob Type: Full-timeAbout UsDatamax Software Group Inc. is a leading provider of digital transformation strategies and solutions. Our team of experts has extensive experience in digital supply chain automation, ERP environments, and mobile app development.Job DescriptionWe are seeking an...

Overview:The Clinical Services Coordinator plays a vital role in managing member care through outreach, engagement, and coordination within the Transitional Care Services Team at Blue Shield of California. This position involves communicating with members and providers to address inquiries related to healthcare benefits and supporting case management...

About the RoleWe are seeking a highly experienced Pharmacy Manager to join our team at Optum. This key position has a substantial impact on our consumers and clinic partners by partnering and advising both on our pharmaceutical care services and benefits.ResponsibilitiesCreate a great consumer and clinic partner experience and continually build solid...