Clinical Reviewer

About the RoleWe are seeking a skilled Clinical Review Nurse to join our team at Actalent. As a Clinical Review Nurse, you will play a critical role in ensuring that our clients receive high-quality care and services.Key ResponsibilitiesConduct thorough reviews of medical records to ensure accuracy and completenessCollaborate with healthcare professionals to...

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 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...

About the RoleThe Clinical Quality Review team at Blue Shield of California is seeking a seasoned leader to oversee the review of potential quality issues that impact our members, providers, and staff. As a key member of our Quality Management and Assurance team, you will work closely with medical directors to identify and address quality concerns, ensuring...

About the RoleThe Appeals and Grievances team at Blue Shield of California is seeking a skilled RN Senior to join our team. As a Clinical Reviewer, you will play a critical role in ensuring that member appeals and grievances are handled in a timely and accurate manner.Key ResponsibilitiesConduct thorough clinical reviews of member-initiated appeals and...

Job Title: Clinical TechnicianAkua Behavioral Health is seeking a skilled Clinical Technician to join our team. As a Clinical Technician, you will play a vital role in supporting our clients in their recovery journey.Key Responsibilities:Provide support to clients during their shift, ensuring their safety and well-being.Conduct orientation to new clients,...

Program Services Clinical CoordinatorMentor Community Services, a part of the Sevita family, provides community-based services for individuals with intellectual and developmental disabilities. Our mission is to empower every person to live a full, more independent life.About the RoleWe are seeking a skilled and compassionate Program Services Clinical...

About the RoleThe Clinical Quality Analytics and Informatics team at Blue Shield of California is seeking a highly skilled Senior Clinical Quality Analyst to join our team. As a Senior Clinical Quality Analyst, you will play a critical role in delivering best-in-class clinical quality analytics and informatics to enable high-quality and affordable...

Job Title: Clinic Travel Nurse RNWe are seeking a skilled and experienced Clinic Travel Nurse RN to join our team at Travel Nurses, Inc. This is a 13-week assignment with 36 hours per week, working 12-hour night shifts.Job DescriptionSpecialty: ClinicDiscipline: RNDuration: 13 weeksHours: 36 hours per weekShift: 12 hours, nightsEmployment Type: TravelAs a...

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 SummaryThe primary purpose of this position is to assist customers with their healthcare needs and maximize health outcomes by filling prescriptions, providing clinical services, advising on therapies, providing excellent customer service, and supervising pharmacy associates. Frequent independent judgments are essential. The incumbent is also required to...

Job DetailsWe are seeking a skilled Travel Nurse RN Clinic to join our team in Rancho Cordova, California. This 13-week assignment offers a unique opportunity to work in a dynamic environment and provide high-quality patient care.Job RequirementsSpecialty: ClinicDiscipline: RNDuration: 13 weeksHours: 36 hours per weekShift: 12 hours, nightsEmployment Type:...

Job SummaryThe primary purpose of this position is to assist customers with their healthcare needs and maximize health outcomes by filling prescriptions, providing clinical services, advising on therapies, and delivering excellent customer service.Key ResponsibilitiesEngage customers seeking guidance on pharmacological and non-pharmacological options for...

Job SummaryThe primary purpose of this position is to assist customers with their healthcare needs and maximize health outcomes by filling prescriptions, providing clinical services, advising on therapies, and providing excellent customer service. The incumbent will also supervise pharmacy associates and perform tasks in a safe manner consistent with Rite...

Job SummaryThe primary purpose of this position is to assist customers with their healthcare needs and maximize health outcomes by filling prescriptions, providing clinical services, advising on therapies, and providing excellent customer service. The incumbent is also required to perform all tasks in a safe manner consistent with Rite Aid policies and state...

About the RoleBlue Shield of California is seeking a highly skilled Medical Director Operations Lead to provide clinical leadership within the Medical Management department. This role will oversee clinical review activities, including utilization management, appeals, and grievances. The successful candidate will have a strong background in healthcare...

Job SummaryWe are seeking a highly skilled Medical Director, Operations to join our team at Blue Shield of California. This is a critical role that requires a strong clinical background, excellent leadership skills, and a deep understanding of behavioral health services and regulations.Key ResponsibilitiesReview and render decisions on pre- and post-service...

Your RoleThe Medical Management team at Blue Shield of California is dedicated to ensuring that our organization is at the forefront of medical, medication, and payment policy to accelerate the emergence of a value-based healthcare system in California. As the Senior Medical Director, Behavioral Health, you will report to the Vice President, Medical...

Job SummaryWe are seeking a skilled Medical Registered Nurse to join our Utilization Management team at Blue Shield of California. As a key member of our team, you will play a critical role in reviewing inpatient stays for our members and ensuring that the guidelines for nationally recognized levels of care are correctly applied.Key ResponsibilitiesPerform...

Job Title: Medical Director, OperationsBlue Shield of California is seeking a highly skilled Medical Director, Operations to join our team. As a key member of our Medical Management team, you will play a critical role in ensuring that our organization is at the forefront of medical, medication, and payment policy to accelerate the emergence of a value-based...