- Kepro (Los Angeles, CA)
- …to being a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team in California. Job ... Summary As a Utilization Clinical Reviewer , you'll harness...a pivotal role in upholding industry benchmarks. This full-time Clinical Reviewer Remote position based… more
- Elevance Health (Costa Mesa, CA)
- …outpatient precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for ... ** Utilization Management Representative I** **Location:** This position will...I** **Location:** This position will work a hybrid model ( remote and office) and participate in health plan sponsored… more
- Molina Healthcare (Long Beach, CA)
- …to a 3 day/12 hour shift from then on._** **_Previous experience with Emergency Room Utilization Management / Utilization Review is required for this role. ... **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_PERMANENT SHIFT WILL BE :_** **_12...with Case Management is a plus._** **_This is a remote role (work from home). Excellent computer multi-tasking skills… more
- Elevance Health (Los Angeles, CA)
- …or regulation, must be in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... received. **Location:** This position will work a hybrid model ( remote and office) and must live within 50 miles...to improve quality, cost, and outcomes. + May provide clinical consultation and serve as clinical /strategic advisor… more
- Elevance Health (Los Angeles, CA)
- …+ Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information. + ... I** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live within 50...HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of… more
- Elevance Health (Los Angeles, CA)
- …Seattle, WA & Woodland Hills, CA. This position will work a hybrid model ( remote and office) and participate in health plan sponsored events. The Ideal candidate ... you will make an impact:** + Conducts pre-certification, continued stay review , care coordination, or discharge planning for appropriateness of treatment setting… more