LEAD CUSTODIAN
San Jose, CA · On-site
$67K - $81K/yr
We offer two medical plans (Anthem Blue Cross [PPO] and Kaiser Permanente (HMO]); dental (Delta ... training in utilization of proper protective gear and equipment as needed. 5. Prepare campus ...
San Jose, CA · On-site
$67K - $81K/yr
We offer two medical plans (Anthem Blue Cross [PPO] and Kaiser Permanente (HMO]); dental (Delta ... training in utilization of proper protective gear and equipment as needed. 5. Prepare campus ...
San Jose, CA · On-site
$67K - $81K/yr
We offer two medical plans (Anthem Blue Cross [PPO] and Kaiser Permanente (HMO]); dental (Delta ... training in utilization of proper protective gear and equipment as needed. 5. Prepare campus ...
$79K - $93K/yr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
$79K - $93K/yr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
$67K - $81K/yr
We offer two medical plans (Anthem Blue Cross [PPO] and Kaiser Permanente (HMO]); dental (Delta ... training in utilization of proper protective gear and equipment as needed. 5. Prepare campus ...
$67K - $81K/yr
We offer two medical plans (Anthem Blue Cross [PPO] and Kaiser Permanente (HMO]); dental (Delta ... training in utilization of proper protective gear and equipment as needed. 5. Prepare campus ...
$79K - $93K/yr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
$79K - $93K/yr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
$79K - $93K/yr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
$79K - $93K/yr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
Laconia, NH · On-site
$31 - $48/hr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
Laconia, NH · On-site
$31 - $48/hr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
$79K - $93K/yr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
$79K - $93K/yr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
Albuquerque, NM · On-site
$79K - $93K/yr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
Albuquerque, NM · On-site
$79K - $93K/yr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
$230K - $300K/yr
Monitor referral utilization and help standardize specialty referral processes * Provide ... Medical, dental, and vision insurance available through Anthem Blue Cross PPO plans * 403(b) ...
$230K - $300K/yr
Monitor referral utilization and help standardize specialty referral processes * Provide ... Medical, dental, and vision insurance available through Anthem Blue Cross PPO plans * 403(b) ...
Laconia, NH · On-site
$31 - $48/hr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
Laconia, NH · On-site
$31 - $48/hr
Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and ...
Leading the team review of all new patient admissions and readmissions for skin integrity needs ... Collaborating to ensure appropriate product utilization and supporting the nursing process for ...
Leading the team review of all new patient admissions and readmissions for skin integrity needs ... Collaborating to ensure appropriate product utilization and supporting the nursing process for ...
Lead the team review of all new patient admissions and readmissions for skin integrity needs ... Collaborate to ensure appropriate product utilization and support the nursing process for ...
Lead the team review of all new patient admissions and readmissions for skin integrity needs ... Collaborate to ensure appropriate product utilization and support the nursing process for ...
Lead the team review of all new patient admissions and readmissions for skin integrity needs ... Collaborate to ensure appropriate product utilization and support the nursing process for ...
Lead the team review of all new patient admissions and readmissions for skin integrity needs ... Collaborate to ensure appropriate product utilization and support the nursing process for ...
Bloomfield, NM · On-site
$10K/mo
Lead the team review of all new patient admissions and readmissions for skin integrity needs ... Collaborate to ensure appropriate product utilization and support the nursing process for ...
Bloomfield, NM · On-site
$10K/mo
Lead the team review of all new patient admissions and readmissions for skin integrity needs ... Collaborate to ensure appropriate product utilization and support the nursing process for ...
Huntley, IL · On-site
$20 - $23/hr
Review and maintain any required logs, check sheets, inspection sheets, and work orders. * Strong ... Demonstrated ability for maintaining maximum utilization/up time on machinery in assigned areas.
Huntley, IL · On-site
$20 - $23/hr
Review and maintain any required logs, check sheets, inspection sheets, and work orders. * Strong ... Demonstrated ability for maintaining maximum utilization/up time on machinery in assigned areas.
Lead the team review of all new patient admissions and readmissions for skin integrity needs ... Collaborate to ensure appropriate product utilization and support the nursing process for ...
Lead the team review of all new patient admissions and readmissions for skin integrity needs ... Collaborate to ensure appropriate product utilization and support the nursing process for ...
Lead the team review of all new patient admissions and readmissions for skin integrity needs ... Collaborate to ensure appropriate product utilization and support the nursing process for ...
Lead the team review of all new patient admissions and readmissions for skin integrity needs ... Collaborate to ensure appropriate product utilization and support the nursing process for ...
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
An Anthem Utilization Review job involves assessing medical services and treatments to ensure they are necessary, cost-effective, and aligned with insurance policies. Professionals in this role review patient records, apply clinical guidelines, and collaborate with healthcare providers to determine coverage eligibility. They help prevent unnecessary procedures while supporting quality patient care. This position typically requires a healthcare background, such as nursing or case management, along with knowledge of insurance regulations and medical necessity criteria.
A typical day in an Anthem Utilization Review position involves evaluating medical records and authorization requests to determine if healthcare services meet established criteria for coverage. You’ll collaborate frequently with healthcare providers, case managers, and internal teams to clarify clinical information and help guide appropriate care pathways. The job is largely desk-based and requires strong organizational skills to manage multiple concurrent cases and meet tight deadlines. Most professionals in this role work within a team structure, sharing best practices and supporting each other in making objective, evidence-based decisions. This dynamic environment offers exposure to a variety of healthcare scenarios and opportunities for ongoing learning in utilization management.
To thrive as an Anthem Utilization Review professional, you need a background in nursing or healthcare, strong analytical abilities, and familiarity with medical terminology and insurance guidelines. Experience with clinical documentation systems, review software, and URAC or NCQA certifications are commonly required. Excellent communication, critical thinking, and attention to detail are crucial soft skills in this position. These capabilities ensure accurate review of medical necessity, effective collaboration with providers, and regulatory compliance, which are vital for quality patient outcomes and cost management.

$67K - $81K/yr
Full-time
Medical, Dental, Vision, Life, Retirement
Posted 8 days ago
Sourced by ZipRecruiter
51 - 200 Employees
San Jose, CA, US
1988