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Weekday Insurance Utilization Review Jobs in California

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

CorVel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

Prime Healthcare

Utilization Review RN

Ontario, CA

$71K - $104K/yr

The methodology is designed to facilitate and insure the achievement of quality, clinical and cost ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

The methodology is designed to facilitate and insure the achievement of quality, clinical and cost ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

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All JobsWeekday Insurance Utilization Review JobsWeekday Insurance Utilization Review Jobs in California

Weekday Insurance Utilization Review information

What is the difference between Weekday Insurance Utilization Review vs Weekday Claims Processor?

AspectWeekday Insurance Utilization ReviewWeekday Claims Processor
Primary RoleAssessing medical necessity and appropriateness of servicesProcessing and reviewing insurance claims for payment
CredentialsOften requires healthcare or insurance certificationsTypically requires insurance or administrative experience
Work EnvironmentHealthcare settings, insurance companiesInsurance companies, healthcare offices
FocusMedical review and authorizationClaims data entry and verification

Weekday Insurance Utilization Review focuses on evaluating medical necessity, while Weekday Claims Processors handle the administrative processing of insurance claims. Both roles are essential in the insurance industry but serve different functions related to claims management and healthcare authorization.

What are the most commonly searched types of Insurance Utilization Review jobs in California? The most popular types of Insurance Utilization Review jobs in California are:
What cities in California are hiring for Weekday Insurance Utilization Review jobs? Cities in California with the most Weekday Insurance Utilization Review job openings:
Weekday Insurance Utilization Review jobs near you

Utilization Review RN

Prime Healthcare Management Inc

Ontario, CA • On-site

$71K - $104K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 10 days ago

Prime Healthcare rating

6.4

Company rating: 6.4 out of 10

Based on 283 frontline employees who took The Breakroom Quiz

639th of 887 rated healthcare providers

Job description

Overview
Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation's leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!
Responsibilities
Responsible for the quality and resource management of all authorizations and referrals with the Prime Healthcare Employee EPO. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the medical necessity, intensity of service and severity of illness.
Qualifications
EDUCATION, EXPERIENCE, TRAINING
Required qualifications:
  1. Minimum 7 years Post Graduate of an accredited school of nursing and a current state Registered Nurse license.
  2. Minimum 3 years RN Utilization Manager working for a Health Plan.
  3. At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals.
  4. Current BCLS (AHA) certificate upon hire and maintain current.
  5. Knowledge of MCG Criteria and/or InterQual Criteria required.
  6. Experience and knowledge in basic to intermediate computer skills.

Preferred qualifications:
  1. Five years acute care nursing experience preferred.
  2. Experience with self-funded health plan preferred.

Pay Transparency
Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $71,760.00 to $104,000.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Employment Status
Full Time
Shift
Days
Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

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