Nurse Reviewer I - Costa Mesa

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. · 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 maximum flexibility and autonomy. · Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessi ...

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 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. · ...

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. · ...

We are seeking a Clinical Review Nurse to evaluate medical records and clinical documentation to support the resolution of claims, member grievances, appeals, and quality-of-care concerns.The Clinical Review Nurse applies clinical acumen to assess medical necessity, appropriatene ...

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 ...

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

The UM Nurse Manager oversees utilization management operations, ensuring regulatory compliance, staff performance, and high-quality care delivery. · Active California RN License · Bachelor's Degree in a Healthcare-Related Field · ...

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. · ...

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. · ...

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 Routine/Standard referrals/authorizations requests in compliance with any Federal, State, Hea ...

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. · ...

Integrated Healthcare Services is seeking a travel nurse RN Manager for a travel nursing job in Costa Mesa California. · ...

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. · ...

+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. ...