healthcare services, continuity or care, and access to care clinical review determinations. The Utilization Management Nurse..., Senior will report to the Manager, Utilization and Medical Review. In this role you will be performing first level...
Your Role The Case Management team performs case management (CM) activities demonstrating clinical judgment... and independent analysis, collaborating with members and those involved with members care including clinical nurses and treating MDs...
(UM) and care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members... and those involved with members’ care including clinical nurses and treating physicians. Your Work In this role, you will: Research...
(UM) and care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members... and those involved with members’ care including clinical nurses and treating physicians. Your Work In this role, you will: Research...
: Complete the following functions in accordance with Managed Resources policies: The Clinical Appeals Review Nurse will review... Clinical Appeals Review nurse will provide the application of current prudent clinical judgment for the case's purpose. The...
Clinical Appeals Nurse Monitors productivity and quality standards of the Clinical Appeals Nurse Conducts yearly evaluations...Clinical Appeals Manager Full time/Remote Salary: $88,000.00 - $110,000.00 per year Managed Resources is a leading...
, and compliant. The Clinical Appeals and CDI Specialist provides nurse consultation services that consist of reviewing...Clinical Appeals and CDI Specialist Full time & Part time/Remote $32 - $45 per hour Coding AID, a division...
SUMMARY: Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits... necessity for admission or continued stay using evidence from the medical record and clinical review tools, as well as input...
. Additionally, this position assists the Senior Appeals & Grievances Nurse with review of written response to requests...Summary Description: The Appeals & Grievances Nurse requires the abilities and knowledge of a California-licensed...
Anticipated End Date: 2025-02-03 Position Title: Nurse Appeals (RN) CA Job Description: Nurse Appeals – Licensed... The Nurse Appeals is responsible for investigating and processing medical necessity appeals requests from members...
Description As the Appeals & Grievances Nurse, you will play a key role in managing and resolving New Century Health... Plan member appeals and grievances. You will: Ensuring timely, accurate, and thorough review of member and provider...
Requisition ID 39856 Department Clinical Resource Management Location Escondido, California Union CNA... admitted to acute level of care. Conducts daily concurrent clinical reviews for utilization/quality management activities...
and appeals. This role entails overseeing a team of utilization review nurses and coordinators, ensuring compliance with clinical... regulatory standards, and enhancing the overall utilization review process to optimize patient care and manage resources...
and appeals. This role entails overseeing a team of utilization review nurses and coordinators, ensuring compliance with clinical... regulatory standards, and enhancing the overall utilization review process to optimize patient care and manage resources...
and utilization review teams across the system. Collaborate with clinical leaders, IT teams, and external vendors to optimize...Role Overview: The System Educator of Care Coordination and Utilization Review is responsible for developing...
City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse (RN) or Licensed Clinical Social Worker... in Case Management include: Clinical Interventions/Discharge and Care Planning Management; Fiscal Management; and Payer...
Management, Post Service, and Appeals. This clinical educator role will be responsible for Utilization Management for all lines...Job Description: Your Role The Medical Care Solutions education team is responsible for all clinical education...
Clinical Documentation Specialist - Auditor (CDS) performs review of inpatient medical records to identify...) Required Licenses/Certifications: Req Valid California Registered Nurse license or foreign medical graduate Req Certified Clinical...
such as physicians, nurse practitioners, allied health professionals, nursing and care coordination regarding clinical documentation... your best work. Job Summary: Utilizes clinical expertise, insurance knowledge, business know-how and high-level communication...
process. Our team members review medical record documentation and apply clinical criteria and guidelines to ensure... Resources Inc., is an Equal Opportunity Employer (EOE) M/F/D/V/SO clinical appeals, cdi specialist, CDIP, CCDS, CCS, RHIA...