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Overview Performs inpatient chart review to determine appropriate DRG assignment and assures appropriate documentation in the chart to support clinical care provided, including severity of illness and risk of mortality which...

JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and...

Minimum QualificationsCitizen of the United StatesProficient in written and spoken EnglishParticipation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP)Preferred...

The purpose of your job position as Care Coordinator Nurse is to provide direct nursing care to residents, including the coordination of care that is safe, timely, effective, efficient, equitable, and resident-centered. You are responsible for...

Remote Rn – Medical Claims Reviewer At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled...

Elevance Health is seeking a Nurse Appeals RN to work virtually full-time, with in-person training required. The role involves investigating medical necessity appeals requests and requires a high school diploma and 2+ years of managed care...

Utilization Management Position Provide health care services regarding admissions, case management, discharge planning and utilization review. Review admissions and service requests within assigned unit for prospective, concurrent...

Are you seeking an opportunity to demonstrate your positive interpersonal skills and high degree of respect for patients, physicians, and coworkers? Would you like to put your outstanding people skills to work in an environment dedicated to helping...

RN Utilization Mgmt Full-Time Day POSITION SUMMARY The RN Utilization Management (RN UM) functions as a support liaisons for a variety of UM functions which may include: the e-TAR process, denials management,...

A leading health services organization is seeking a Clinical Education RN to support staff development in Los Angeles, CA. This role involves facilitating educational processes for various health staff and requires a Bachelor's of Science in...

Nurse Consultant I (NS) The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health,...

A healthcare staffing agency is looking for a Travel Nurse RN Clinical Document Improvement Specialist based in Tarzana, California. The role involves managing patient complaints, providing clinical oversight, and performing medical record...

Bristol Hospice seeks an Admissions RN in Lakewood, CA 90712, who is responsible for building community relationships and facilitating hospice care access. The ideal candidate will possess an RN license in California and demonstrate effective...

CVS Health Job Opportunity We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care...

Please contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Nikhil Jhajharia at email address [email protected] can be reached on # 630-576-1935. We have...

Urgent Hiring for "Remote Clinical Review Nurses" Job Description: Review approximately 20 cases a day for medical necessity. Advocate for and protect members from unnecessary hospital...

Payrate: $60.00 - $62.00/hr. Summary: The main function of the nurse is to provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and...

Your RoleThe Clinical Quality Team is responsible for reviewing and abstracting medical records to capture data and to ensure accuracy and completeness. The Clinical Quality Reviewer - Nurse, Senior will report to the Manager, Clinical Quality...

Thekey-2 is seeking Licensed Registered Nurses (RNs) for high-end private duty care in Los Angeles, California. Enjoy a flexible schedule as a 1099 independent contractor, providing personalized 1:1 care in patients' homes. Pay starts at $65/hr,...

Admissions Nurse The Admissions RN is a registered nurse and an Interdisciplinary Team member whose primary responsibility is to present VITAS services and philosophy to patients and families in a manner that results in the admission of...

Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical...

West Coast University is looking for a Nursing Academic Specialist in Los Angeles, California. In this role, you will guide nursing students, enhancing their educational experience through targeted support and collaboration with faculty.

JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include gathering, analyzing and providing date for regulatory...

Join Us At CVS Health We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply,...

RN - Clinic Nurse Out-patient clinic nurse City: Los Angeles State: CA Start Date: 01/06/2025 End Date: 04/07/2025 Duration: 13 Week(s) Shift: 5X8 Days Shifts Per Week: 5 Scheduled...