Clinical Review Nurse Specialist

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...

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 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:...

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...

The Clinical Nurse Specialist will engage with multidisciplinary teams to formulate and execute care strategies for designated patients. This role involves evaluating patient reactions, adjusting care plans as necessary, and providing guidance to newly graduated nurses and support personnel.This position is with Alta Hospitals, a healthcare provider...

Title: Clinical Nurse SpecialistLocation: Long Beach, CADepartment: Adult Wound CareStatus: Full TimeShift: Nights (12 Hours)Pay Range: $47/Hr - $73/HrBonus: $5,000 Sign onAt MemorialCare Health System, we are committed to delivering exceptional healthcare services to our communities while fostering a remarkable working environment for our staff....

TRB and Associates, Inc. is seeking a qualified and driven building plan review specialist with a valid registration as a civil, structural, mechanical, or architectural engineer (California registration preferred). The successful candidate should possess at least two years of experience in plan evaluation and/or design for commercial, industrial, and...

TRB and Associates, Inc. is seeking a qualified and driven Building Plans Review Specialist with a valid registration as a civil, structural, mechanical, or architectural engineer (California registration preferred). The successful candidate will possess at least two years of relevant experience in reviewing plans and/or design for commercial, industrial,...

About the RoleWe are seeking a highly skilled Clinical Nurse Auditor Consultant to join our team at Blue Shield of California. As a key member of our Clinical Access Program's Facility Site Review team, you will play a critical role in ensuring that all MediCal members have access to safe, high-quality providers.Key ResponsibilitiesConduct thorough clinical...

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 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...

Clinical Support Specialist Position at THE CHILDREN'S CLINICAre you dedicated to making a difference in the lives of children and families in need?THE CHILDREN'S CLINIC, a healthcare provider committed to delivering exceptional services to the community, is seeking a skilled Clinical Support Specialist to enhance our team.Key Responsibilities:Deliver direct...

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...

TRB and Associates, Inc. is seeking a qualified and driven Plan Review Engineer with a valid registration in civil, structural, mechanical, or architectural engineering (California registration preferred). The successful candidate will possess at least two years of experience in plan evaluation and/or design for commercial, industrial, and residential...

Title: Clinical Nutrition Specialist II Location: Long Beach Department: Pediatric Nutrition Status: Full Time Shift: Days Pay Range*: $37.98/hr - $55.10/hr At MemorialCare Health System, we are committed to delivering exceptional healthcare services to our communities while fostering a remarkable working environment for our staff. MemorialCare...

Position Overview Title: Registered Nurse Location: Long Beach, CA Department: Step Down Unit Employment Type: Full Time Work Schedule: Days (12 Hours) Compensation Range: $47/Hr - $73/Hr At Long Beach Memorial Medical Center, we are committed to delivering exceptional healthcare services to our community while fostering a supportive work...

Position OverviewThe Clinical Access Program's Facility Site Review team is dedicated to ensuring that all MediCal members receive access to safe and high-quality healthcare providers. The Clinical Nurse Auditor, Consultant will report directly to the Clinical Training and Auditing Manager. In this capacity, you will evaluate physical site locations to...

About the RoleThe Clinical Services Specialist will be responsible for delivering high-quality direct clinical services, including tele-counseling, to students with Autism Spectrum Disorder (ASD) and/or learning disabilities. This role involves working within the CIP Clinical Framework to provide assessments, support plans, case management, as well as...

About the RoleWe are seeking a highly skilled Clinical Nurse Auditor Consultant to join our team at Blue Shield of California. As a key member of our Clinical Access Program's Facility Site Review team, you will play a critical role in ensuring that all MediCal members have access to safe, high-quality providers.Key ResponsibilitiesConduct thorough clinical...

Job Summary:CommonSpirit Health is seeking a skilled Clinical Nutrition Specialist to join our team. As a key member of our healthcare team, you will play a vital role in providing medical nutritional therapy to patients.Responsibilities:Conduct comprehensive nutritional assessments to identify patients' nutritional needs and develop personalized plans of...