- Molina Healthcare (Long Beach, CA)
- …clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License, Certification, Association** Active, ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...of proactive approaches to improve and standardize overall retrospective claims review . * Ensures core system is… more
- Emanate Health (Covina, CA)
- …decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete ... States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity… more
- ICW Group (San Diego, CA)
- …required; ensures quality and appropriate service delivery. + Communicates effectively with medical providers, the assigned claims examiner, injured worker and ... clinical assessment and evaluate needs for treatment in worker's compensation claims . The Telephonic Nurse Case Manager will negotiate and coordinate appropriate… more