Clinical Utilization Review Specialist
2 weeks ago
The Clinical Utilization Review Specialist will play a critical role in promoting quality and cost-effective medical care by applying clinical acumen and policies to prior authorization specialty referral requests. This position requires a strong understanding of healthcare and managed care principles, as well as excellent communication and interpersonal skills.
Key Responsibilities- Review referrals and authorizations for medical necessity and appropriateness
- Communicate effectively with providers, staff, and health plans regarding medical management and referral authorization issues
- Maintain a working relationship with PACM colleagues, pre-auth coordinator team, high-risk nurse case managers, inpatient nurse case managers, medical directors, and network management
- Research alternative care plans and assist in routing members to the most appropriate care/setting
- Act as liaison between case managers, UM coordinators, contracted providers, and members/families
- Perform case reviews based on key screening outpatient indicators and evaluate PCP-submitted plans of care for completeness, consistency, and adherence to guidelines
- Maintain regulatory turnaround time standards and document all necessary information in authorization notes
- Graduate from an accredited nursing program
- Active California licensed vocational nurse license
- Minimum of 1 year of processing referrals and authorizations experience
- Knowledge of healthcare and managed care principles, NCQA, CMS, HSAG, and health plan requirements related to utilization management
- Proficient in MS Office programs and typing 30 WPM with accuracy
Regal Medical Group offers a comprehensive benefits package, including employer-paid comprehensive medical, pharmacy, and dental, vision insurance, zero co-payments for employed physician office visits, flexible spending account, employer-paid life insurance, employee assistance program, behavioral health services, 401k retirement savings plan, income protection insurance, and other benefits.
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Utilization Review Specialist
6 days ago
Northridge, California, United States Regal Medical Group Full timeJob Title: Utilization Review SpecialistAt Regal Medical Group, we are seeking a highly skilled Utilization Review Specialist to join our team. As a Utilization Review Specialist, you will play a critical role in promoting the quality and cost-effectiveness of medical care by applying clinical acumen and policies to prior authorization specialty referral...
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Clinical Nurse Specialist RN NICU
4 weeks ago
Northridge, California, United States Dignity Health Full timeJob Title: Clinical Nurse Specialist RN NICUJob Summary:We are seeking a highly skilled Clinical Nurse Specialist RN NICU to join our team at Dignity Health – Northridge Hospital Medical Center. As a Clinical Nurse Specialist, you will be responsible for providing expert nursing care to critically ill neonates and their families in our state-of-the-art...
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Clinical Nurse Specialist RN NICU
2 weeks ago
Northridge, California, United States CommonSpirit Health Full timeJob Title: Clinical Nurse Specialist RN NICUJob Summary:We are seeking a highly skilled Clinical Nurse Specialist RN NICU to join our team at Northridge Hospital Medical Center. The successful candidate will have a strong background in neonatal intensive care nursing and will be responsible for providing expert nursing practice to promote quality patient...
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Clinical Nurse Specialist RN NICU
1 week ago
Northridge, California, United States Unavailable Full timeJob SummaryUnavailable is seeking a highly skilled Clinical Nurse Specialist RN to join our Neonatal Intensive Care Unit (NICU) team. As a Clinical Nurse Specialist RN, you will be responsible for providing expert nursing care to critically ill neonates and their families.Key Responsibilities:Develop and implement standards of care for neonatal...
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Clinical Nurse Specialist RN NICU
2 weeks ago
Northridge, California, United States Unavailable Full timeJob Title: Clinical Nurse Specialist RN NICUJob Summary:We are seeking a highly skilled Clinical Nurse Specialist RN NICU to join our team at Northridge Hospital Medical Center. The ideal candidate will have a strong background in neonatal nursing and a passion for delivering high-quality patient care.Responsibilities:Utilize expert nursing practice to...
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Clinical Nurse Specialist RN NICU
7 days ago
Northridge, California, United States Unavailable Full timeJob Title: Clinical Nurse Specialist RN NICUJob Summary:We are seeking a highly skilled Clinical Nurse Specialist RN NICU to join our team at Unavailable. The successful candidate will be responsible for providing expert nursing care to critically ill neonates and their families in our state-of-the-art Neonatal Intensive Care Unit (NICU).Key...
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Clinical Nurse Specialist RN NICU
4 weeks ago
Northridge, California, United States CommonSpirit Health Full timeJob Summary:As a Clinical Nurse Specialist in the Neonatal Intensive Care Unit (NICU) at Northridge Hospital Medical Center, you will play a vital role in providing high-quality patient care to critically ill neonates and their families. With a strong focus on quality and safety, you will work collaboratively with the medical team to develop and implement...
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Clinical Nutrition Specialist
7 days ago
Northridge, California, United States Dignity Health Full timeAbout the Role:We are seeking an experienced and compassionate dietitian to provide expert nutritional care to our patients, ensuring they receive the best possible guidance for their dietary needs during their hospital stay.Responsibilities:Completes patient nutritional assessment and establishes plan of care for patients nutritional requirements.Utilizes...
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Perinatal Education Specialist Labor
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Perinatal Education Specialist Labor Delivery
1 month ago
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Perinatal Safety Specialist
6 days ago
Northridge, California, United States Dignity Health Full timePerinatal Education SpecialistJob Summary:We are seeking a highly skilled Perinatal Education Specialist to join our team at Dignity Health – Northridge Hospital Medical Center. As a key member of our Labor and Delivery department, you will be responsible for promoting safe care for mothers and babies by implementing and supporting patient safety and...
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Perinatal Education Specialist Labor Delivery
4 weeks ago
Northridge, California, United States Dignity Health Full timePerinatal Education Specialist Job DescriptionJob Summary:We are seeking a highly skilled Perinatal Education Specialist to join our team at Dignity Health – Northridge Hospital Medical Center. As a Perinatal Education Specialist, you will be responsible for implementing, promoting, and supporting perinatal patient safety and quality of care initiatives...
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Clinical Nutrition Specialist
7 days ago
Northridge, California, United States Dignity Health Full timeRole SummaryWe are seeking a skilled and compassionate Clinical Dietitian to provide expert nutritional care to our patients at Dignity Health – Northridge Hospital Medical Center.Key ResponsibilitiesAssess and evaluate patients' nutritional needs, considering age-specific populations, cultural, religious, and ethnic concerns.Develop, review, and implement...
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Northridge, California, United States Unavailable Full timePerinatal Education SpecialistJob SummaryWe are seeking a highly skilled Perinatal Education Specialist to join our team at Northridge Hospital Medical Center. As a Perinatal Education Specialist, you will be responsible for implementing, promoting, and supporting perinatal patient safety and quality of care initiatives and programs.Key...
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Clinical Denial Specialist
4 weeks ago
Northridge, California, United States Regal Medical Group Full timeJob SummaryThe Denial Nurse will play a critical role in promoting quality and cost-effective medical care by applying clinical acumen and policy guidelines to denials. This position requires a strong understanding of medical management principles and the ability to communicate effectively with various stakeholders.Key ResponsibilitiesReview denials for...
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Clinical Pharmacist
1 month ago
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Clinical Pharmacist
3 weeks ago
Northridge, California, United States Regal Medical Group Full timeJob Title: Clinical PharmacistRegal Medical Group is seeking a highly skilled Clinical Pharmacist to join our team. As a Clinical Pharmacist, you will play a critical role in improving the quality of care for our members by developing and implementing clinical criteria, guidelines, and policies to enhance pharmacy-related quality measures.Key...
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Clinical Pharmacist
1 month ago
Northridge, California, United States Regal Medical Group Full timeJob SummaryThe HEDIS Clinical Pharmacist will play a critical role in improving quality measures related to medications and disease states. This position requires a strong clinical background and expertise in medication management, disease state management, and quality improvement initiatives.Key ResponsibilitiesDevelop and implement clinical criteria and...
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Behavioral Health Specialist
7 days ago
Northridge, California, United States Regal Medical Group Full timeJob DescriptionRegal Medical Group is seeking a highly skilled Behavioral Health Specialist to join our team. As a key member of our clinical management team, you will play a critical role in providing expertise and consultation for the management of behavioral health conditions and medications.The primary purpose of this position is to support clinical...
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Physiatrist/Physical Medicine Specialist
2 weeks ago
Northridge, California, United States CommonSpirit Health Full time{"Responsibilities": {"Patient Care": ["Provide high-quality patient care by diagnosing and treating various medical conditions", "Develop and implement comprehensive treatment plans to meet the unique needs of each patient", "Conduct thorough medical examinations and histories to ensure accurate diagnoses", "Communicate effectively with patients, families,...