Quality Review Nurse - Covina, CA

Provides expertise to the organization in the form of quality management review and performance improvement knowledge. Supports the hospital and medical staff in Performance Improvement activities and works within the organization's Performance Improvement plan. · ...

+h2>Job summary · Provides expertise to the organization in the form of quality management review and performance improvement knowledge. Supports the hospital and medical staff in Performance Improvement activities and works within the organization's Performance Improvement plan. ...

Provides expertise to the organization in the form of quality management review and performance improvement knowledge. Supports the hospital and medical staff in Performance Improvement activities and works within the organization's Performance Improvement plan. · ...

Provides expertise to the organization in the form of quality management review and performance improvement knowledge. Supports the hospital and medical staff in Performance Improvement activities and works within the organization's Performance Improvement plan. · ...

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. · ...

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. · ...

+Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. · ...

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. · ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy. The nurse reviewer I will be responsible for conducting preauthorization reviews for diagnostic imaging services by utilizing appropriate policies and clinical guidelines. · Collaborat ...

The Nurse Reviewer is responsible for conducting preauthorization reviews for diagnostic imaging services by utilizing appropriate policies and clinical guidelines. · Collaborates with healthcare providers and members to promote the most appropriate use of diagnostic imaging. · W ...

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist their Health Services Department. · ...

The Nurse Reviewer is responsible for conducting preauthorization reviews for diagnostic imaging services by utilizing appropriate policies and clinical guidelines.Conducts initial medical necessity review of exception preauthorization requests for services requested outside of t ...

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. · ...

This role enables associates to work virtually full-time with the exception of required in-person training sessions providing maximum flexibility and autonomy. · ...

We are looking for an experienced CA-licensed Utilization Review Nurse to assist our Health Services Department. The nurse will utilize their clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria. · ...

The Utilization Management Inpatient Review Nurse is responsible for managing inpatient conducting thorough reviews of clinical documentation and applying clinical knowledge in accordance with relevant Care Guidelines and CMS regulations. · ...

This role enables associates to work virtually full-time, except for required in-person training sessions. · Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medi ...

As a Concurrent Review Nurse, you will be responsible for coordinating and overseeing the care of patients receiving inpatient medical services. · ...

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. · ...

Provide clinical review of medical claims and post service appeals. Facilitate appropriate investigation of issues and management of medical services and benefits administration while maintaining SCAN timeframe standards. · ...