Clinical Utilization Specialist

**Overview of Blue Shield of CaliforniaWe are a not-for-profit health plan that provides high-quality healthcare services to millions of Californians. Our mission is to make a meaningful difference in the lives of our members by delivering innovative, patient-centered care.About the RoleWe are seeking an experienced Clinical Review Specialist - Utilization...

About the RoleThe Senior Utilization Management Specialist will be responsible for reviewing medical documents and applying clinical criteria to establish the most appropriate level of care. This role requires strong analytical and problem-solving skills, as well as excellent communication and collaboration abilities.

At Blue Shield of California, we're seeking an experienced Senior Clinical Utilization Review Nurse to join our Facility Compliance Review team. This role is ideal for a highly skilled professional who can ensure medical necessity and billing standards are met.Key Responsibilities:Conduct retrospective utilization reviews and first-level determination...

OverviewAt Blue Shield of California, we are committed to delivering high-quality healthcare services. Our Utilization Management team plays a vital role in ensuring that our members receive the best possible care.In this exciting opportunity, you will work as a Clinical Review Nurse, Senior - Utilization Management, and be responsible for reviewing medical...

About the RoleAs a senior member of the Facility Compliance Review team at Blue Shield of California, you will play a critical role in ensuring that post-service prepayment facility claims are thoroughly reviewed for contract compliance, industry billing standards, medical necessity, and hospital-acquired conditions/never events. Reporting directly to the...

Job OverviewWe are seeking a highly skilled and experienced Diabetes Specialist to join our team as a Clinical Diabetes Specialist. As a member of our team, you will play a critical role in delivering unparalleled clinical education and product training for people with diabetes and healthcare providers.This is an excellent opportunity to work with...

Job SummaryThe Clinical Review Specialist, Senior at Blue Shield of California will lead retrospective utilization reviews and first-level determination approvals for members using BSC evidenced-based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business such as Medicare and FEP.Key...

About the Role    We are seeking an experienced Senior Utility Coordinator to join our team at HDR. In this role, you will be responsible for managing utility infrastructure projects, working closely with project teams, utility companies, and clients to ensure successful project outcomes.Your key responsibilities will include:Assisting with the...

Job Title: Clinical Nurse SpecialistFifth Commandment Healthcare Staffing, LLC is seeking a highly skilled Clinical Nurse Specialist to join our team. This role requires 2 years of acute care experience, with a focus on Cardiac Telemetry.Salary:$80,000 - $120,000 per yearJob Description:We are looking for a dedicated and compassionate nurse to work in a...

Job Title: Clinical Audit Specialist**Salary:** $70,000 - $90,000 per yearWe are seeking a skilled Clinical Audit Specialist to join our team at Molina Healthcare. In this role, you will be responsible for supporting the prevention, detection, investigation, and reporting of healthcare fraud, waste, and abuse.Key Responsibilities:Perform accurate and...

Key ResponsibilitiesAs a Utilization Management Coordinator, you will play a vital role in managing the flow of prior authorization requests, coordinating with providers and payers, and ensuring compliance with regulatory requirements.You will work collaboratively with our cross-functional teams to develop and implement effective solutions to optimize...

Job Title: PICU Clinical Nurse SpecialistJob Summary:Fifth Commandment Healthcare Staffing, LLC is seeking an experienced PICU Clinical Nurse Specialist to join our team. As a PICU Clinical Nurse Specialist, you will be responsible for providing high-quality patient care and leading the nursing team in the Pediatric Intensive Care Unit.Key Responsibilities:-...

Clinical Social Work Specialist Job DescriptionWe are looking for a highly motivated and experienced Clinical Social Work Specialist to join our team.In this role, you will be responsible for counseling patients, interpreting psychosocial needs, and conducting surveys and studies relating to psychosocial status.You will also have the opportunity to review...

Job Title: Clinical Nurse Specialist - Pediatric GIWe are seeking a skilled and compassionate Clinical Nurse Specialist to join our team at MemorialCare Health System. This is an exciting opportunity to make a meaningful difference in the lives of children and families.About the Role:As a Clinical Nurse Specialist, you will provide expert nursing care to...

Job SummaryWe are seeking a skilled Clinical Support Specialist to join our team at Pacific Neuropsychiatric Specialists Inc.About the RoleThis is a full-time position that offers a competitive compensation package including medical, dental, and vision insurance, paid time off, and hourly rate based on skill, experience, and tenure.Key...

We are looking for a highly motivated and dependable Clinical Support Specialist to join our team at JOON HEE LEE DMD DENTAL CORPORATION. As a key member of our dental staff, you will be responsible for providing exceptional patient care and supporting our dentists in various procedures.The ideal candidate will have at least one year of experience in the...

Role SummaryWe are seeking a skilled Physical Therapist to join our team at California Rehabilitation & Sports Therapy in Lakewood. As a valued member of our outpatient ortho clinic, you will play a crucial role in providing exceptional patient care and contributing to the success of our organization.About the RoleThis is an exciting opportunity for a...

About TotalMed StaffingTotalMed is a leading healthcare staffing agency with a mission to provide top-notch clinical professionals to facilities nationwide.We are dedicated to igniting purpose in healthcare by matching skilled caregivers with the right organizations to ensure exceptional patient outcomes.Job OverviewTotalMed is seeking an experienced...

Clinical Specialist Opportunity We are seeking a skilled Clinical Specialist to join our team in the GI Lab at TotalMed. This is an exciting opportunity for experienced nurses to work with our esteemed clients and contribute to providing exceptional patient care. As a valued member of our team, you will be responsible for delivering high-quality nursing...

About the RoleWe are seeking a highly skilled Clinical Admissions Specialist to join our team at Roots Through Recovery. This is a challenging yet rewarding role that requires a unique blend of clinical expertise, communication skills, and attention to detail.Key Responsibilities:Assess prospective clients to determine their eligibility for our program,...