- Molina Healthcare (Long Beach, CA)
- …business needs.** ** Remote position.** **Knowledge/Skills/Abilities** + Conducts quality review of the clinical determination letters generated for members, ... **Job Description** **Job Summary** The Clinical Correspondence Review Nurse is responsible...3 years Managed Care experience + Minimum 3 years Utilization Management Review experience **Required Licensure or… 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
- Molina Healthcare (Long Beach, 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
- Veterans Affairs, Veterans Health Administration (Los Angeles, CA)
- …HBPC policies and procedures to include performance improvement, patient safety, utilization review , emergency preparedness, and staff safety. Responsible for ... HBPC program. The HBPC Program Director is responsible for directing the program's clinical and administrative services to ensure that the plan complies with local… more