- UCLA Health (Los Angeles, CA)
- …is responsible for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review Nurse ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital...of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical necessity… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred: Experience in Medi-Cal managed care. 1 year of experience in UM / Prior Authorization . Skills Required: Demonstrated proficiency in Medical ... support the safety net required to achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management ( UM ) Specialist by… more
- University of Southern California (Alhambra, CA)
- …major duties of the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate that the appropriate patient status is ... assigned upon admission and prior to discharge; InterQual or MCG reviews are completed...1. Demonstrates sound clinical knowledge base regarding CM standards, UM standards, clinical standards of care, NCQA requirements, CMS… more
- Elevance Health (Los Angeles, CA)
- …**Utilization Management Representative I** is responsible for coordinating cases for precertification and prior authorization review . **How you will make an ... provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the… more