Voca Healthcare is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fairfield, California. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 09/05/2026 Durat...

case reviews, check medical records, speak with patients and care providers regarding treatment, and respond to the plan...

+ reviews a day - Previous experience with screening criteria including Cerner, InterQual, and MCG is required - Excellent...

. Documentation and Reporting: Document findings from utilization reviews in the appropriate systems and ensure accurate record...

Responsibilities The George Washington University Hospital (GW Hospital) continues to be a leader in providing the highest level of quality and compassionate healthcare for the D.C. Region. U.S. News & World Report has just released the 2...

Oversees service delivery authorizations and provides quality assurances of service delivery records Reviews all service...

We’re seeking a future team member for the role of Director, Credit Risk Review to join our Model Risk team. This role is located in New York City, New York. In this role, you’ll make an impact in the following ways: Lead the development...

case reviews evaluating medical necessity, appropriateness, or quality of care. Provide evidence-based assessments... depending on case complexity Most cases take 1-3 hours to complete; shorter reviews may take less than 1 hour Strong written...

clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy... appeals are completed thoroughly and on a timely basis. Interface with managed care organizations, external reviews...

of Job This position is responsible for conducting reviews on admissions, continued stays, and readmissions, as well as managing the denial... longer meet medical necessity criteria for inpatient care. These reviews are conducted independently of treatment teams...

for prior authorization reviews, claims determinations, Medical Management Committee reviews, provider consultation..., you will conduct prior authorization and claims reviews, provide consultation to providers and agency staff, support the Medical...

management (UM) medical-necessity reviews and level-of-care determinations for requested services using the organization... routing/escalation per policy (including Independent Review Organization (IRO) processes when required). Document reviews...

determination. Conduct prospective, concurrent, and retrospective reviews, including inpatient behavioral health reviews... and members to support timely and accurate determinations. Complete appeal reviews in collaboration with the Grievance...

reviews, and internal quality control functions for claims processing for Fee For Service and Waiver beneficiaries...

Required Qualifications Series 7 and 24 are required Must have performed redline day to day regulatory reviews of marketing content...

authority from the C Senior Vice Provost for Research and Innovation. The UMCIRB reviews human research plans... from all across ECU's campus, the ECU Health system and has affiliations with other entities to conduct their reviews. Such research...

review and provide clearance on potential negative news alerts for new clients or during periodic client reviews. Perform... prospect client reviews and provide recommendations prior to onboarding prospects as well as other referrals from line units...

and site visits. Initiates, performs and/or reviews construction loan disbursements. Interacts with real estate clients... Manager, loan officer) and other Columbia associates. Analyzes, reviews and comments on Construction Loan Agreements...

to ensure transactions meet suitability standards, regulatory requirements, and company guidelines. Conduct reviews, monitoring... management initiatives. Maintain accurate documentation and records of suitability reviews, determinations, escalations...

Day to Day Responsibilities: The Commercial Appeals and Grievance RN reviews and processes appeals resulting... while processing these member-generated appeals. In this role, the RN will perform accurate and timely first-level reviews according...