Clinical Review Specialist

Job Summary:We are seeking a Clinical Review Nurse to join our Utilization Management team. This role is responsible for reviewing inpatient stays and determining medical necessity using nationally recognized levels of care guidelines.About the Role:Perform prospective, concurrent, and retrospective utilization reviews to determine medical necessity and...

Job OverviewThe Clinical Care Specialist, Senior at Blue Shield of California plays a vital role in reviewing inpatient stays for our members, ensuring that care meets nationally recognized levels of necessity. This position reports to the Utilization Management Nurse Manager and involves clinical information review, discharge planning, and transfers as...

Job SummaryIn this challenging and rewarding role as a Senior Utilization Management Nurse at Blue Shield of California, you will be responsible for reviewing inpatient stays to ensure medical necessity in compliance with state and federal regulations. Your expertise in clinical review, discharge planning, and presenting cases to the Medical Director will...

CorVel Healthcare Corporation is seeking a skilled Utilization Review Specialist to join our team. As a key member of our healthcare services department, you will be responsible for conducting utilization reviews to ensure medical necessity and appropriateness of treatment plans.In this role, you will analyze clinical data, communicate with healthcare...

We are seeking an experienced Clinical Specialist to join our team at the Neurology Clinic, PC. As a key member of our multidisciplinary team, you will play a vital role in providing high-quality patient care and support.Key ResponsibilitiesThe ideal candidate will possess excellent nursing skills, with a strong background in neurological therapies. Key...

Job Title: Travel Nurse Clinical SpecialistOverview of the RoleWe are seeking a dedicated and skilled travel nurse to join our team as a clinical specialist in a clinic setting. This exciting opportunity allows for professional growth and development while making a meaningful impact on patient care.The successful candidate will possess excellent clinical...

Job OverviewWe are seeking a Senior Healthcare Utilization Specialist to join our team at Blue Shield of California.Job SummaryThe Senior Healthcare Utilization Specialist is responsible for reviewing inpatient stays and determining medical necessity in compliance with state and federal regulations. This role involves conducting clinical reviews, discharge...

About the RoleThe Clinical Pharmacy Specialist will report to the Manager of Medical Benefit Drug Utilization and support the Blue Shield of California Pharmacy and Therapeutics Committee process.

About the OpportunityWe are seeking a skilled Clinical Support Specialist to join our team at Rock Medical Group in Rancho Cordova, California.This is a 13-week travel nursing assignment with a variety of shifts available. Our ideal candidate will have ICU, ED, or transfer center experience and be able to facilitate transfers from hospitals within Dignity...

Job Title: Medical Support SpecialistWe are seeking a highly motivated and dependable individual to join our team as a Medical Support Specialist at the Neurology Clinic, PC.As a Medical Support Specialist, you will be responsible for handling administrative and clinical duties in a timely manner. This includes performing routine clinical tasks to support...

Job Title: Prior Authorization Specialist RN**Job Summary:** We are seeking an experienced RN to join our team as a Prior Authorization Specialist. This role will involve reviewing prior authorization requests, performing first-level determination approvals, and developing member-centered documentation.Estimated Salary: $80,000 - $105,000 per yearDuties and...

Job Overview:Boutique law firm Denovo Review in Southern California seeks an experienced Environmental Law Specialist to join their team. The ideal candidate will have a strong background in environmental law and be able to work independently to manage cases.The role involves meeting with clients, keeping them updated on matter developments, identifying...

Company Overview:Inland Empire Health Plan (IEHP) is a leading healthcare organization dedicated to healing and inspiring the human spirit. As a dynamic and innovative team, we strive to provide exceptional care and services to our members.Salary: $80,059.20 - $106,059.20 per yearJob Description:We are seeking an experienced Senior Special Investigations...

Job SummaryWe are seeking a skilled Clinical Support Specialist to join our team at Rock Medical Group. This exciting opportunity allows you to work in a dynamic transfer center environment, facilitating transfers and providing excellent patient care.

Job DescriptionAt Blue Shield of California, we are seeking a highly skilled Care Coordination Specialist - Utilization Management to join our team.About the RoleThis is an exciting opportunity to work in a dynamic environment where you will play a critical role in ensuring that our members receive high-quality care while also promoting cost-effective...

About the Role:We are seeking a highly skilled Healthcare Utilization Specialist to join our team at Blue Shield of California. As a member of our Utilization Management department, you will play a critical role in reviewing inpatient stays for our members and applying nationally recognized levels of care guidelines.This position requires strong analytical...

At CorVel Healthcare Corporation, we're seeking a skilled Healthcare Utilization Review Specialist to join our team. This role plays a crucial part in ensuring the highest quality patient care while maintaining efficient cost management.

**Overview**At Blue Shield of California, we are committed to delivering exceptional healthcare services. We are seeking a highly skilled Medical Director, Utilization Management Specialist to join our team.**Salary Range**The estimated salary range for this role is $165,990.00 - $248,930.00 per year, based on experience and location.**Job Description**As a...

We are seeking a highly organized and detail-oriented Record Filing Specialist to join our team. This individual will be responsible for maintaining accurate and up-to-date records, ensuring compliance with company policies and procedures.Job SummaryThe Record Filing Specialist will compile, verify, type, and file individual records, maintain files and...

About the RoleAs a Radiology Physician with Mercy Radiology Group, you will be part of a dynamic and growing organization providing exceptional medical care to patients throughout the Sacramento region.We are committed to delivering high-quality, compassionate care, and our imaging department is staffed by experienced radiologists and certified radiologic...