Utilization Review Nurse - Orange County, CA

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

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. · ...

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 ...

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

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 ...

As a registered nurse (RN), you will provide care for patients dealing with illness or injury. Depending on your role, you'll work at a hospital, outpatient center, private practice, home health telemedicine nursing facility clinic or other facility. · ...

The Utilization Review Registered Nurse ensures that the team is properly trained to conduct medical necessity reviews on incoming Pre-Service/Prior-Authorization, Retrospective and Post Claims reviews on Urgent/Expedited and Routine/Standard referrals/authorizations requests in ...

+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 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 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. · ...

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 their Health Services Department. · ...

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, 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 ...

+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. · +BSN preferred ...

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. · ...

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

+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. ...

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. · ...