Concurrent Review Jobs in California (NOW HIRING)

Inpatient concurrent review, especially working with complex medical patients, including aged, blind, disabled. * Sound decision-making skills including problem solving, critical thinking, and good ...

These functions include performance of pre-service, concurrent and retrospective utilization review, and provider claims dispute reviews. In addition, the Medical Director, Utilization Management ...

Review and evaluate proposed services utilizing medical criteria and/or established policies and procedures. This includes review of submitted medical documentation and/or photographs. * Determine ...

Description JOB SUMMARY The Concurrent Case Management LVN is responsible for supporting inpatient and post-acute care coordination and concurrent review activities to ensure medically appropriate ...

Under the direction of the Inpatient/Post-Acute Manager and RN leadership, the Concurrent Case Management LVN performs concurrent review, monitors inpatient and post-acute utilization, supports ...

JOB SUMMARY The Concurrent Case Management LVN is responsible for supporting inpatient and post-acute care coordination and concurrent review activities to ensure medically appropriate, timely, and ...

These functions include performance of pre-service, concurrent and retrospective utilization review, and provider claims dispute reviews. In addition, the Medical Director, Utilization Management ...

Authorizes requested services according to Concurrent Review team guidelines. Contacts the health networks and/or CalOptima Health Customer Service department regarding health network enrollments.

Review and resolve authorization denials, medical necessity denials, level-of-care downgrades (inpatient to observation), and concurrent review denials issued by commercial, managed care, Medicare ...

Review and resolve authorization denials, medical necessity denials, level-of-care downgrades (inpatient to observation), and concurrent review denials issued by commercial, managed care, Medicare ...

Authorizes requested services according to Concurrent Review team guidelines. * Contacts the health networks and/or CalOptima Health Customer Service department regarding health network enrollments.

Our client is seeking an experienced Concurrent Review Registered Nurse (RN) to join its Utilization Management team. In this role, you will perform concurrent reviews, prior authorizations, medical ...

Our client is seeking an experienced Concurrent Review Registered Nurse (RN) to join its Utilization Management team. In this role, you will perform concurrent reviews, prior authorizations, medical ...

Our client is seeking an experienced Concurrent Review Registered Nurse (RN) to join its Utilization Management team. In this role, you will perform concurrent reviews, prior authorizations, medical ...

Our client is seeking an experienced Concurrent Review Registered Nurse (RN) to join its Utilization Management team. In this role, you will perform concurrent reviews, prior authorizations, medical ...

Position Summary The Utilization Management (UM) LVN is responsible for performing clinical review activities to support the prior authorization, concurrent review, retrospective review, and care ...

Job Duties • Facilitates medical review of prospective, retrospective, and concurrent review of appeals for denied prior authorizations. Includes standard and expedited cases, inpatient, outpatient ...

Job Duties • Facilitates medical review of prospective, retrospective, and concurrent review of appeals for denied prior authorizations. Includes standard and expedited cases, inpatient, outpatient ...

Performs concurrent, and retrospective medical record reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers. Ensures medical ...

Performs concurrent, and retrospective medical record reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers. Ensures medical ...