Utilization Review Specialist

Job Summary: We are seeking a highly skilled Medical Management Specialist to join our team at E-talentnetwork. This role is responsible for ensuring appropriate, cost-effective, and high-quality care for patients.About the Role:This position involves conducting utilization management activities in accordance with health plan policies and regulatory...

About UsDignity Health - California Hospital Medical Center has been serving the Los Angeles community since 1887. As a 318-bed acute care nonprofit hospital, we offer a wide range of services, including a Level II trauma center and comprehensive cardiac and surgical services.Our team is committed to delivering exceptional patient care and improving health...

About the PositionWe are seeking a skilled Clinical Utilization Specialist to join our team at Dignity Health. In this role, you will be responsible for reviewing medical records to ensure appropriate admission status and continued hospitalization.You will work closely with attending physicians, consultants, and care coordination staff to utilize...

Qualifications and ExperienceTo be successful in this role, you should possess:Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties.A strong understanding of network services, managed care, and appropriate utilization of services.Current, unrestricted clinical license(s).Post-graduate experience in direct...

About the RoleWe are seeking a skilled Nurse Reviewer I to join our team at Elevance Health. This role involves conducting preauthorization reviews for diagnostic imaging services, working closely with healthcare providers and members to ensure quality member outcomes.The ideal candidate will have a strong clinical background in nursing, with experience in...

Role SummaryWe are seeking a skilled Utility Detection Specialist to join our team. As an Advanced Locate Technician, you will play a critical role in providing high-quality utility detection services to our clients.Key ResponsibilitiesManage the locate schedule with the CSR team Plan and organize daily work schedule to call on existing and potential clients...

About the RoleWe are seeking an experienced Employment Law Referral Specialist to join our dynamic team at Denovo Review. As a key member of our staff, you will be responsible for coordinating referrals with other law firms and maintaining relationships with referral partners.The successful candidate will have a strong understanding of litigation flow and be...

Job OverviewWe are seeking a skilled US Attorney to join our team for onsite document review projects in Downtown Los Angeles. As a Contract Document Review Specialist, you will work closely with our clients to ensure accurate and efficient review of documents. If selected, you will be required to work onsite off a company-issued laptop, which would be...

Job Details:We are seeking a skilled Private Utility Specialist to join our team at USIC. As a key member of our crew, you will be responsible for providing utility locating services while building the business.Salary: $28-$30/hour + monthly bonusResponsibilities:Identify, locate, and mark all utilities within a requested job scopeManage sales cycle to close...

Job SummaryIn this challenging role, you will play a crucial part in ensuring our members receive the necessary healthcare services. As a Utilization Management Nurse Specialist RN II, you will facilitate and coordinate medically necessary referrals, ensuring timely and accurate determinations. You will also generate approval, modification, and denial...

Job OverviewMedPOINT Management is seeking an experienced Risk Pool Review Specialist to join our team. As a key member of our Auditing & Recoveries unit, you will be responsible for reviewing and analyzing Risk Pool Summaries to ensure the accuracy and integrity of hospital claims paid by MPM.**Key Responsibilities**Review Risk Pool Summaries to identify...

Job SummaryWe are seeking a highly skilled Utilization Management Nurse to join our team at Presidential Staffing Solutions, LLC. As a key member of our team, you will play a crucial role in reviewing patient files and treatment methods to ensure optimal efficiency and effectiveness.Your primary responsibility will be to monitor the activity of staff,...

Role Summary:We are seeking an experienced Registered Nurse (RN) to join our team as a Utilization Management Policy Initiatives Specialist. The successful candidate will have at least 8 years of previous experience in Clinical Nursing and a strong background in performing and creating clinical documentation.The ideal candidate will be responsible for...

Job OverviewPALTmed seeks a skilled RN Access Case Manager to provide care coordination and ensure positive partnerships with nursing, physicians, and other key disciplines. This role emphasizes the importance of medical necessity in achieving authorization and reimbursement for services.About PALTmedWe are a nonprofit, regional healthcare network committed...

Why Join Our TeamKaiser Permanente offers a comprehensive benefits package, including medical, dental, and vision coverage, as well as a 401(k) plan with employer matching. We also offer paid time off, holidays, and flexible scheduling to support your work-life balance.In addition to our competitive compensation and benefits, we offer opportunities for...

About the RoleWe are seeking a seasoned Utility Coordinator to join our team at Dabri, Inc. as a Project Delivery Specialist. This role is a key position in supporting the Advanced Transportation Management Program (ATMP) for Transportation/Roadway projects at the Los Angeles World Airports (LAWA).The ideal candidate will possess extensive experience in...

Overview:Adams & Martin Group is a leading provider of litigation support services, partnering with top law firms to deliver high-quality document review solutions. As a key member of our team, you will play a crucial role in supporting complex litigation matters, utilizing your fluency in foreign languages to drive success.

OverviewThe Utilization Management Physician Advisor role at MLK Community Healthcare involves acting as a liaison between hospital administration, clinical staff, and support personnel. This part-time position requires regular interaction with the Senior Director of Care Management, care management staff, and healthcare team members to discuss selected...

**About the Opportunity**Denovo Review, a national full-service business law firm with 200 attorneys and locations across the United States, is seeking a talented Junior-level Bankruptcy Associate to join its Century City office in Los Angeles. The ideal candidate will be admitted to practice in the state of California and have a minimum of 2 years of...

Job OverviewThe MedPOINT Management team is seeking an experienced Outpatient UM Clinician to join our team. This role is responsible for ensuring a thorough review of outpatient precertification/preauthorization referrals for members requiring outpatient services.In close collaboration with the Medical Director, the successful candidate will work towards...