Eureka, CA · On-site
$1.9K/wk
... prior authorizations, continued stay reviews, and utilization management using InterQual criteria while ensuring compliance with CMS, Medicare regulations, and hospital guidelines in an acute care ...
Eureka, CA · On-site
$1.9K/wk
... prior authorizations, continued stay reviews, and utilization management using InterQual criteria while ensuring compliance with CMS, Medicare regulations, and hospital guidelines in an acute care ...
Santa Ana, CA · On-site
Utilization Review Technician Under direction of the Utilization Review Technician Supervisor, the ... Monitors patient charts and records to provide to responsible parties and request for authorization ...
Santa Ana, CA · On-site
Utilization Review Technician Under direction of the Utilization Review Technician Supervisor, the ... Monitors patient charts and records to provide to responsible parties and request for authorization ...
Whittier, CA · On-site
$2.8K/wk
... Specialty Utilization Review Job ID 18027156 Job Title Utilization Review RN Weekly Pay $2800.0 ... authorizations and reimbursement Client Details City Whittier State CA Zip Code 90603
Whittier, CA · On-site
$2.8K/wk
... Specialty Utilization Review Job ID 18027156 Job Title Utilization Review RN Weekly Pay $2800.0 ... authorizations and reimbursement Client Details City Whittier State CA Zip Code 90603
Santa Ana, CA · On-site
SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review ... Monitors patient charts and records to provide to responsible parties and request for authorization ...
Santa Ana, CA · On-site
SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review ... Monitors patient charts and records to provide to responsible parties and request for authorization ...
Santa Ana, CA · On-site
$24.80 - $37.31/hr
SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review ... Monitors patient charts and records to provide to responsible parties and request for authorization ...
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Santa Ana, CA · On-site
$24.80 - $37.31/hr
SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review ... Monitors patient charts and records to provide to responsible parties and request for authorization ...
Orange, CA · On-site
$38 - $53/hr
Job Summary Our client is seeking a Utilization Review Nurse responsible for managing the complete ... Apply LCD/NCD to pre-service authorizations when determining appropriate clinical tiers.
Orange, CA · On-site
$38 - $53/hr
Job Summary Our client is seeking a Utilization Review Nurse responsible for managing the complete ... Apply LCD/NCD to pre-service authorizations when determining appropriate clinical tiers.
Alhambra, CA · On-site
$43 - $53/hr
Position Summary The PACE Utilization Review Specialist - RN oversees clinical utilization ... Ensure appropriate service authorization for hospitalizations, referrals, and specialty services.
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Alhambra, CA · On-site
$43 - $53/hr
Position Summary The PACE Utilization Review Specialist - RN oversees clinical utilization ... Ensure appropriate service authorization for hospitalizations, referrals, and specialty services.
Vivo HealthStaff is searching for a Utilization Review RN for a hybrid position for a health plan ... Ensures medical necessity determinations, service authorization and concurrent denials are managed ...
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Vivo HealthStaff is searching for a Utilization Review RN for a hybrid position for a health plan ... Ensures medical necessity determinations, service authorization and concurrent denials are managed ...
Vivo HealthStaff is searching for a Utilization Review RN for a hybrid position for a health plan ... Ensures medical necessity determinations, service authorization and concurrent denials are managed ...
Quick apply
Vivo HealthStaff is searching for a Utilization Review RN for a hybrid position for a health plan ... Ensures medical necessity determinations, service authorization and concurrent denials are managed ...
Vivo HealthStaff is searching for a Utilization Review RN for a hybrid position for a health plan ... Ensures medical necessity determinations, service authorization and concurrent denials are managed ...
Quick apply
Vivo HealthStaff is searching for a Utilization Review RN for a hybrid position for a health plan ... Ensures medical necessity determinations, service authorization and concurrent denials are managed ...
Bakersfield, CA · On-site
$41.05 - $64.68/hr
Utilization Review Nurse - Per Diem Compensation: The estimated pay for this position is $41.0485 ... Answer questions from providers regarding reimbursement, prior authorization and other ...
Bakersfield, CA · On-site
$41.05 - $64.68/hr
Utilization Review Nurse - Per Diem Compensation: The estimated pay for this position is $41.0485 ... Answer questions from providers regarding reimbursement, prior authorization and other ...
Ontario, CA · On-site
$71K - $104K/yr
Responsibilities Responsible for the quality and resource management of all authorizations and ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...
Ontario, CA · On-site
$71K - $104K/yr
Responsibilities Responsible for the quality and resource management of all authorizations and ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...
$71K - $104K/yr
Responsibilities Responsible for the quality and resource management of all authorizations and ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...
$71K - $104K/yr
Responsibilities Responsible for the quality and resource management of all authorizations and ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...
Bakersfield, CA · On-site
$41.05 - $64.68/hr
Utilization Review Nurse - Per Diem Compensation: The estimated pay for this position is $41.0485 ... Answer questions from providers regarding reimbursement, prior authorization and other ...
Bakersfield, CA · On-site
$41.05 - $64.68/hr
Utilization Review Nurse - Per Diem Compensation: The estimated pay for this position is $41.0485 ... Answer questions from providers regarding reimbursement, prior authorization and other ...
San Jose, CA · On-site
$80 - $95/hr
Hospital RN - Care Coordination & Utilization Review Immediate need for a talented Hospital RN - ... Manage authorizations and payer-related workflows * Maintain compliance with regulatory standards ...
San Jose, CA · On-site
$80 - $95/hr
Hospital RN - Care Coordination & Utilization Review Immediate need for a talented Hospital RN - ... Manage authorizations and payer-related workflows * Maintain compliance with regulatory standards ...
Ontario, CA · On-site
$71K - $104K/yr
Responsibilities Responsible for the quality and resource management of all authorizations and ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...
Ontario, CA · On-site
$71K - $104K/yr
Responsibilities Responsible for the quality and resource management of all authorizations and ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...
$71K - $104K/yr
Responsible for the quality and resource management of all authorizations and referrals with the ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...
$71K - $104K/yr
Responsible for the quality and resource management of all authorizations and referrals with the ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...
San Jose, CA · On-site
$80 - $95/hr
Hospital RN - Care Coordination & Utilization Review Immediate need for a talented Hospital RN - ... Manage authorizations and payer-related workflows * Maintain compliance with regulatory standards ...
San Jose, CA · On-site
$80 - $95/hr
Hospital RN - Care Coordination & Utilization Review Immediate need for a talented Hospital RN - ... Manage authorizations and payer-related workflows * Maintain compliance with regulatory standards ...
Sunnyvale, CA · On-site
$80 - $95/hr
Immediate need for a talented Hospital RN - Care Coordination & Utilization Review . This is a 06 ... Manage authorizations and payer-related workflows * Maintain compliance with regulatory standards ...
Sunnyvale, CA · On-site
$80 - $95/hr
Immediate need for a talented Hospital RN - Care Coordination & Utilization Review . This is a 06 ... Manage authorizations and payer-related workflows * Maintain compliance with regulatory standards ...
Bakersfield, CA · On-site
$27.07 - $33.37/hr
ESSENTIAL DUTIES The primary responsibility of the Utilization Review Specialist is to review ... stay, authorizations and denials for patients. The UR Specialist is responsible for contacting ...
Bakersfield, CA · On-site
$27.07 - $33.37/hr
ESSENTIAL DUTIES The primary responsibility of the Utilization Review Specialist is to review ... stay, authorizations and denials for patients. The UR Specialist is responsible for contacting ...
| Aspect | Authorization Utilization Review | Claims Reviewer |
|---|---|---|
| Credentials | Typically requires healthcare or insurance-related certifications, such as RN, CPC, or licensed healthcare professionals | Often requires similar credentials, focusing on insurance policies and claims processing |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Insurance companies, third-party administrators, healthcare organizations |
| Industry Usage | Used to assess medical necessity before approving services | Used to evaluate claims for payment accuracy and compliance |
Authorization Utilization Review and Claims Reviewer roles both involve insurance and healthcare knowledge, but Authorization Utilization Review focuses on pre-authorization of services, while Claims Review centers on post-service claims assessment. Understanding these differences helps clarify career paths and job expectations in healthcare insurance.
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Cynet Health is a TJC certified MBE and one of the fastest-growing healthcare staffing firms in the US providing Health Med and Health IT staffing and consulting services to countless hospitals, SNFs, clinics, labs, CROs, health & wellness centers, pharmacies, and other medical facilities across the United States. Headquartered in Sterling, Virginia, we are a certified Minority-Owned Business Enterprise and a recognized Diversity Supplier. Vision Our Vision is to be the most trusted and reliable provider for healthcare companies and medical facilities across the United States. Mission Our mission is to serve our healthcare customers with excellence and make a meaningful difference in the lives of patients and our communities.
Recruiting and staffing services
501 - 1,000 Employees
Sterling, VA, US
2015
