TravSource is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Arcata, California. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 10/26/2026 Duration: 13 ...

criteria, and annotation best practices. General Job Profile - Reviews the work of others. - Develops innovative approaches...

Description Providence Queen of the Valley Medical Center is committed to delivering top-notch healthcare, earning recognition from the Association of California Healthcare Districts (ACHD) Award in recognition of our outstanding contribu...

American Traveler is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fort Myers, Florida. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 10/26/2026 Durat...

required for highly-complex and/or escalated reviews, and providing expert guidance to team members and partnering with the health care... and/or escalated reviews, and providing expert guidance to team members and partnering with the health care team, members...

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on ...

Responsibilities The Valley Health System has expanded into an integrated health network that serves more than two million people in Southern Nevada. Starting with in 1979, the Valley Health System has grown to include , , , Benefit Hig...

pharmaceuticals. This role involves performing quality compliance reviews of cGMP analytical data and results from the QC Microbiology.... Responsibilities Provide quality assurance reviews of laboratory raw data and reports, including environmental monitoring...

Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being.... Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. Reviews...

Performs concurrent reviews of members for appropriate care and setting to determine overall health and appropriate level... of care Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay...

: Conduct utilization reviews of patient records to assess medical necessity and appropriateness of care. Collaborate...

referrals. The Clinical Quality Reviewer will conduct comprehensive quality reviews, evaluate clinical concerns, determine... to apply clinical judgment during complex case reviews Behavioral health experience preferred for occasional support needs Preferred...

conducting admission criteria assessments, benefits eligibility reviews, care coordination, concurrent and continued stay reviews... patients. Perform care coordination and utilization reviews including concurrent, continued stay, pre-certification, prior...

to perform the function of Technical Reviewer in the ACP Technical Review Unit. The Technical Reviewer will perform reviews... of applicant submissions for asbestos removal and perform related inspections, as necessary. These reviews will help address the...

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the.... Key Details: Must reside in est time zone. Performs concurrent reviews of member for appropriate care and setting...

Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services... prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines...

authorizations, pre-certifications, concurrent reviews, and continued-stay reviews. Support medical necessity using ASAM, LOCUS...-to-peer reviews. Track authorized units, coverage dates, and payer deadlines. Collaborate with clinical and admissions teams...

team. This position is responsible for completing second-party case reviews, managing reports, identifying error trends...

is met. The analyst performs quality reviews of random and targeted samples of completed readmission audits and applies expert... audits. Perform quality reviews of random and targeted samples of Clinical Readmission Review Auditor work to validate...

and accurate information. Uploads and monitors external reviews sent to external review companies. Corresponds with external... Management Platform with accuracy and timeliness. Facilitates and schedules Peer-to-peer requests. Reviews accuracy of member...