- 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 (Los Angeles, 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 is a remote position. Ideal candidates will live within 50 miles of an Elevance Health PulsePoint… more
- Molina Healthcare (Los Angeles, 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
- Molina Healthcare (Los Angeles, CA)
- …seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and ... to work some weekends and holidays. This is a remote position and you may work from home._** **_Further...all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence… more
- Molina Healthcare (Los Angeles, CA)
- …are seeking a LVN (Licensed Vocational Nurse) with experience in Prior Authorizations, Utilization Review / Utilization Management and knowledge of Interqual ... or master's degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience**… 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
- Amgen (Thousand Oaks, CA)
- …for advancing the quality systems, for overseeing incoming material batch record review and release as well as IQA investigations and change controls. **Key ... "fit for purpose" for effective phase appropriate practices in Process Development, Clinical and Commercial functions. + Ensure QMS site process owners maintain… more