TravSource is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Torrance, California. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 10/26/2026 Duration: 1...

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

Assured Nursing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Torrance, California. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 10/19/2026 Durati...

are completed thoroughly and on a timely basis. Interface with managed care organizations, external reviews, and other payers.... Communicate with physicians to schedule peer to peer reviews. Accurately report denials. Qualifications and requirements...

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 ...

How you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays... and on a timely basis. Interface with managed care organizations, external reviews, and other payers. Communicate with physicians...

appraisals, prepares appraisal reviews and internal scorecards, and helps ensure appraisal activities are executed in alignment... with appraisal engagements and reviews. Conduct market research and provide analytical support to strengthen appraisal review...

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...

and enhance employee engagement in all roles. Works under general supervision. Responsibilities: • Reviews and approves evaluation.... Reviews data submitted from the field staff to ensure accuracy and follows up on any documentation that requires correction...

, unlimited CEUs, and a supportive team-focused work environment What You Will Do Conduct clinical reviews of patient records...

utilizing customer service skills. Note & document conversations for AR Aging reviews. Works with responsible parties...

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

and throughout the continuum of care. Duties include but not limited to: Conducts admission and continued stay reviews... per guidelines to ensure medical necessity of level of care and hospitalization for multiple entities. Reviews medical record...

Responsibilities Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case...

Details: This fully remote role supports Oregon Medicaid by conducting behavioral health clinical reviews for both inpatient..., during, and after services to ensure level of care and services are medically appropriate Performs prior authorization reviews related...

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

outlier provider performance, conducting comprehensive clinical record reviews, and delivering individualized coaching... level of care and services are medically appropriate Performs prior authorization reviews related to mental health...

, clinical, medical, reporting and other internal departments as needed. Responsibilities Reviews pertinent patient... while maintaining NCQA and health plan`s required timeframes. Regularly reviews and monitors information on pended claims identified...

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the... in multiple states. Performs concurrent reviews of member for appropriate care and setting to determine overall health...