Utilization Review RN

Job SummaryAs a RN Care Coordinator at LifeBridge Health, you will play a critical role in managing individualized patient-centered care through the use of the Nursing Process and Primary Nursing principles. Your primary responsibility will be to provide care coordination and management for patient populations, focusing on improved health outcomes, reduced...

Position Overview:As a vital member of the Utilization Management team at Saviance Technologies, your primary responsibility will be to conduct thorough inpatient medical necessity and utilization assessments. This role is crucial in ensuring that our members receive the appropriate care they require at the right time. Key Responsibilities:Your daily...

About the RoleThe Facility Compliance Review team at Blue Shield of California reviews post-service prepayment facility claims for contract compliance, industry billing standards, medical necessity, and hospital-acquired conditions/never events. As a Utilization Management Nurse, Senior, you will report to the Senior Manager, Facility Compliance Review. In...

Your Role The Utilization Management team reviews the inpatient stays for our members under the guidelines for nationally recognized levels of care. The Utilization Management Nurse, Senior will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and review clinical information provided by the...

Job Summary:Saviance Technologies is seeking a highly skilled Care Review Clinician I to join our Utilization Management team. As a key member of our team, you will be responsible for conducting inpatient medical necessity and utilization reviews, ensuring our members receive appropriate care when they need it.Key Responsibilities:Conduct thorough reviews...

Job SummaryWe are seeking a skilled Clinical Review Specialist to join our team at Saviance Technologies. As a key member of our Utilization Management team, you will play a critical role in ensuring that our members receive the right care at the right time.Key ResponsibilitiesConduct daily reviews and evaluations of members requiring hospitalization and/or...

Job SummarySaviance Technologies is seeking a skilled Clinical Review Clinician I to join our team. As a key member of our Utilization Management team, you will play a critical role in ensuring that our members receive the right care at the right time.Key ResponsibilitiesConduct daily review and evaluation of members requiring hospitalization and/or...

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior...

Job SummarySaviance Technologies is seeking a highly skilled Care Review Clinician I to join our Utilization Management team. As a key member of our team, you will be responsible for conducting inpatient medical necessity and utilization reviews, ensuring our members receive appropriate care when they need it.Key Responsibilities:Conduct thorough reviews and...

Position OverviewJob Title: Quality Peer Review CoordinatorLocation: Long BeachDepartment: Quality AssuranceEmployment Type: Full-timeWork Schedule: Day ShiftCompensation: $53.97/hr - $78.24/hrAt Long Beach Memorial Medical Center, we are committed to delivering exceptional healthcare services. As a part of our nonprofit integrated health system, we value...

Job OverviewAs a key member of our clinical team, the Clinical Review Nurse Specialist is responsible for evaluating medical documentation to confirm medical necessity and the appropriate level of care. This role involves utilizing MCG/InterQual guidelines, state and federal regulations, billing, and coding standards, as well as Molina policies to ensure...

Description Title: RN, Coordinator Quality Peer Review Location: Long Beach Department: Q uality Assurance Status: Full-time Shift: Day Pay Range* : $53.97/hr - $78.24/hr  MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care,...

Job OverviewPosition SummaryUtilizing extensive clinical expertise, the incumbent will be responsible for evaluating documentation to confirm medical necessity and the appropriate level of care in accordance with MCG/InterQual standards, state and federal regulations, billing and coding guidelines, as well as Molina policies. This role involves validating...

Position Overview:As a vital member of the Utilization Management team at Saviance Technologies, your primary focus will be on performing inpatient medical necessity and utilization assessments. This role is essential in ensuring that our members receive the necessary care at the right time. Key Responsibilities:Your daily responsibilities will include:...

Job SummaryMolina Healthcare Services (HCS) collaborates with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential.HCS staff work to ensure that patients progress toward desired...

Job OverviewAs a Clinical Review Nurse, you will leverage your clinical expertise to assess documentation for medical necessity and the appropriate level of care. Your role will involve utilizing MCG/InterQual guidelines, state and federal regulations, billing and coding standards, and Molina policies to validate medical records and claims submitted,...

Position OverviewJob Title: Quality Assurance RN CoordinatorLocation: Long BeachDepartment: Quality AssuranceEmployment Type: Full-timeWork Schedule: Day ShiftCompensation: $53.97/hr - $78.24/hrAt Long Beach Memorial Medical Center, we are committed to delivering exceptional healthcare services. As a part of our nonprofit integrated health system, we value...

Job SummaryWe are seeking a highly skilled RN, Quality Peer Review Coordinator to join our team at Long Beach Memorial Medical Center. In this role, you will play a critical part in ensuring the highest quality patient care by coordinating the evaluation of quality patient care data and physician peer review of identified variances.Key...

Position Overview:As a vital member of the Utilization Management team at Saviance Technologies, your primary focus will be on performing inpatient medical necessity assessments and utilization reviews. Your efforts will ensure that our members receive the necessary care in a timely manner. Key Responsibilities:Your daily responsibilities will...

About the RoleWe are seeking a highly skilled Senior Utilization Management Nurse to join our team at Blue Shield of California. As a key member of our Facility Compliance Review team, you will play a critical role in ensuring the accuracy and integrity of our medical claims processing.Key ResponsibilitiesPerform retrospective utilization reviews and...

Your Role The Facility Compliance Review team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events. The Utilization Management Nurse, Senior will report to the Senior Manager, Facility Compliance Review. In this role you will be reviewing medical...