Nurse Reviewer I - San Juan

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.Conducts initial medical necessity review of exception preauthorization requests for services requested outside of t ...

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 ...

The Southwest Healthcare Regional office in Temecula, CA is seeking a Full-Time Central Utilization Review Nurse who will be responsible for carrying out utilization management functions by planning, coordinating, and managing patient needs during hospitalization and throughout t ...

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The Southwest Healthcare Regional office in Temecula, CA is seeking a Full-Time Central Utilization Review Nurse who will be responsible for carrying out utilization management functions by planning, coordinating, and managing patient needs during hospitalization and throughout t ...

The Southwest Healthcare Regional office in Temecula, CA is seeking a Per-Diem RN Central Utilization Review Nurse who will be responsible for carrying out utilization management functions by planning, coordinating, and managing patient needs during hospitalization and throughout ...

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

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. · ...

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 ...

The Clinical Review Nurse evaluates medical records and clinical documentation to support the resolution of claims member grievances appeals and quality-of-care concerns. · ...

The Clinical Review Nurse evaluates medical records and clinical documentation to support the resolution of claims, member grievances, appeals, and quality-of-care concerns.Using clinical judgment and appropriate application of CMS regulations, Medicare Advantage requirements, an ...

Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Utilization Review Nurse. · ______________________________________ · NOTE- THIS IS 100% REMOTE ROLE & ONLY W ...

Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Utilization Review Nurse. · ______________________________________ · NOTE- THIS IS 100% REMOTE ROLE & ONLY W ...

Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Utilization Review Nurse. · ______________________________________ · NOTE- THIS IS 100% REMOTE ROLE & ONLY W ...

Description · Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.    · Who Are We?   · Clever Care was created to meet the ...

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. · ...

Certification Details · Registered Nurse (RN) - California State License · Job Details · Ensures that the team are properly trained to conduct medical necessity reviews on incoming Pre-Service/Prior-Authorization, Retrospective and Post Claims reviews on Urgent/Expedited and Rout ...

Integrated Healthcare Services is seeking a travel nurse RN Manager, Utilization Review for a travel nursing job in Costa Mesa, California. · Job Description & Requirements · Specialty: Utilization Review · Discipline: RN · Duration: 10 weeks · 40 hours per week · Shift: 8 ...

Integrated Healthcare Services is seeking a travel nurse RN Manager, Utilization Review for a travel nursing job in Costa Mesa, California. · Job Description & Requirements · Specialty: Utilization Review · Discipline: RN · Duration: 10 weeks · 40 hours per week · Shift: 8 hours, ...

Certification DetailsRegistered Nurse (RN) - California State License · Job DetailsEnsures that the team are properly trained to conduct medical necessity reviews on incoming Pre-Service/Prior-Authorization, Retrospective and Post Claims reviews on Urgent/Expedited and Routine/St ...