Showing 1-20 of 49
Showing 1-20 of 49
Claims Review Nurse jobs near Northridge, CA

L.A. Care Health PlanLos Angeles, CAEst. salary: $69,000 - $92,000 a year

Advanced SAS programming skills working with data types such as membership, provider, claims and encounters (5 years preferred)....

Cliffside MalibuMalibu, CAEst. salary: $39,000 - $52,000 a year

Registered Nurse (RN). Perform Insurance Reviews for both in and out of network policies. The Utilization Review Specialist requires effective communication and...

Excel Managed Care & Disability Services, Inc.CaliforniaEst. salary: $66,000 - $93,000 a year

Nurse Case Manager RN Registered NurseHours:. Active California Registered Nurse, RN License (BSN preferred)....

WellCareLos Angeles, CAEst. salary: $43,000 - $58,000 a year

Preferred Licensed Practical Nurse (LPN). Required 2 years of experience in directly related HEDIS medical record review and/or Quality Improvement with...

Regal Medical GroupNorthridge, CA

Works with the Regional Medical Director, Burbank region on a daily basis to review Burbank Comprehensive Care Program hospitalizations with both home visit...

CignaGlendale, CAEst. salary: $35,000 - $44,000 a year

Discussion of disability claims with claim managers; Licensed Registered Nurse with current licensure in your state of residency....

HealthCare PartnersEl Segundo, CAEst. salary: $49,000 - $68,000 a year

Referrals and appeals review. Clinical review criteria and HMO benefits. Conducts review of procedures related to referral....

Genesis HealthcareTorrance, CA

Reviews and revises service plan as indicated; Complies with applicable legal requirements, standards, policies and procedures including but not limited to...

CignaGlendale, CAEst. salary: $37,000 - $53,000 a year

Discussion of disability claims. Strong skills in medical assessment/medical record review. Licensed Registered Nurse with current licensure in California....

Care1st Health PlanMonterey Park, CAEst. salary: $72,000 - $98,000 a year

Licensed as an active California registered nurse or vocational nurse. The CCS Case Manager is responsible for performing clinical nurse review activities for...

Genesis HealthcarePlaya del Rey, CA

Works in close collaboration with the Center Nurse Executive and department heads to assure professional development and career goals are met....

Genesis HealthcareLos Angeles, CA

Provides direction to nurse management regarding Individual Performance Improvement Plans, problem resolution, and disciplinary actions;...

LifeCare Assurance CompanyLos Angeles, CAEst. salary: $31,000 - $41,000 a year

Recommends Nurse Care Manager Visits, Medical Consultant Reviews, Surveillance, Independent Medical Evaluations when required....

Kelly ServicesNewbury Park, CAEst. salary: $27,000 - $34,000 a year

Refers cases requiring clinical review to a Nurse reviewer. Managing incoming calls or incoming post services claims work....

HealthCare PartnersTorrance, CAEst. salary: $51,000 - $71,000 a year

Previous care management, utilization review or discharge planning experience. Reviews patients’ clinical records within 48 hours of SNF admission....

Clinical Management ConsultantsPasadena, CAEst. salary: $88,000 - $120,000 a year

Outpatient Cancer Center Nurse RN Job in Pasadena CA. The Outpatient Cancer Center Nurse will provide oversight of utilization management activities ensuring...

Clinical Management ConsultantsWhittier, CAEst. salary: $87,000 - $130,000 a year

The Hospital Oncology Staff Nurse RN will work with a supportive team of peers and will collaborate with physicians in patient care and utilization review...

Huntington Ambulatory Surgery CenterPasadena, CAEst. salary: $42,000 - $55,000 a year

Participates in the Patient Care Committee and Clinical Review Board Committee meetings. Responsible for Quality Indicator studies as assigned by the Operations...

Integrated Resources, IncLong Beach, CAEst. salary: $55,000 - $72,000 a year

Medical Review Nurse. 1-3 years clinical nursing experience, including 1 year Utilization Review and/or Medical Claims Review experience....

Avanti Hospitals, LLCGardena, CAEst. salary: $36,000 - $48,000 a year

Assigns reviews to Case Managers as directed by the Case Management Director. Completes appropriate approvals and denials by the Case Management director, of...


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