Clinical Utilization Review Nurse
11 hours ago
We are seeking a skilled Clinical Utilization Review Nurse to join our team at KPC Global MSO. As a key member of our Utilization Review and Case Management Department, you will play a critical role in ensuring the quality and efficiency of our medical management services.
Key Responsibilities- Coordinate and review medical records to assess adherence to admission and treatment criteria
- Participate in Case Management and Treatment Team meetings to ensure seamless communication and collaboration
- Provide education and training to healthcare professionals on utilization review and case management best practices
- Review patient charts to identify areas for improvement and implement changes to optimize care
- Communicate with fiscal intermediaries, patients, and families to ensure timely and accurate referral determinations
- CA LVN license required; CA RN license preferred
- Bachelor's or Master's degree in Social Work, behavioral or mental health, nursing, or related field preferred
- 3-5 years of acute care experience; 2 years of managed care experience in UM/CM Department preferred
- Knowledge of CMS, State Regulations, URAC, and NCQA guidelines preferred
KPC Global MSO offers a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and detail-oriented Clinical Utilization Review Nurse looking for a challenging and rewarding role, we encourage you to apply.
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Clinical Utilization Review Nurse
15 hours ago
Corona, California, United States KPC GLOBAL MEDICAL CENTERS INC Full timeJob SummaryWe are seeking a skilled Clinical Utilization Review Nurse to join our team at KPC Global Medical Centers Inc. This role will involve reviewing medical records, participating in case management and treatment team meetings, and serving as an educator to various departments.Key ResponsibilitiesCoordinate and review medical records, as assigned to...
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Utilization Review LVN
14 hours ago
Corona, California, United States KPC GLOBAL MEDICAL CENTERS INC Full timeJob SummaryAs a Utilization Review LVN at KPC GLOBAL MEDICAL CENTERS INC, you will play a critical role in ensuring the efficient and effective delivery of healthcare services. Key ResponsibilitiesCoordinate and review medical records for assigned caseloads, ensuring compliance with Federal, State, and intermediary guidelines.Participate in Case Management...
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Clinical Appeals Nurse
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Wet Utilities Foreman
2 days ago
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LVN - Outpatient Clinic Nurse
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Clinical Documentation Specialist
1 week ago
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Clinical Documentation Specialist III
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Clinical Documentation Specialist/Coder III
3 weeks ago
Corona, California, United States KPC GLOBAL MEDICAL CENTERS INC. Full timeJob SummaryKPC Global Medical Centers Inc. is seeking a highly skilled Clinical Documentation Specialist/Coder III to join our team. As a key member of our healthcare team, you will be responsible for conducting clinically based concurrent and retrospective reviews of inpatient medical records to ensure accurate and compliant documentation.Key...
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Medical Assistant II
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Clinical Documentation Specialist/Coder III
3 weeks ago
Corona, California, United States KPC Global MSO Full timeJob SummaryWe are seeking a highly skilled Clinical Documentation Specialist/Coder III to join our team at KPC Global MSO. As a key member of our coding team, you will be responsible for conducting clinically based concurrent and retrospective reviews of inpatient medical records to ensure accurate and compliant documentation.Key ResponsibilitiesConduct...
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Director of Case Management
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Clinical Documentation Specialist
3 weeks ago
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Travel Nurse RN Clinic Infusion Position
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Clinical Documentation Specialist/Coder III
2 weeks ago
Corona, California, United States KPC GLOBAL MEDICAL CENTERS INC. Full timeJob SummaryThe Clinical Documentation Specialist/Coder III is a key member of our team at KPC Global Medical Centers Inc., responsible for conducting thorough and accurate reviews of inpatient medical records. This role requires a strong clinical knowledge and understanding of disease processes, as well as excellent written and verbal communication...
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Licensed Vocational Nurse
1 month ago
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