WorkCare - Irvine, CA

Review of Family Medical Leave Act, short-term or long-term disability requests. Be a liaison with TPA to assist with claims management....

Estimated: $73,000 - $100,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

Care1st Health Plan - Monterey Park, CA

Licensed as an active California registered nurse or vocational nurse. Performs reviews of outpatients with complex medical and social problems....

Estimated: $62,000 - $88,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

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Network Medical Management - Alhambra, CA

Review claim/referral appeals and unauthorized claims, forwarding them for medical director/UMC review and determination when appropriate....

Estimated: $71,000 - $96,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

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Network Medical Management - Alhambra, CA

Review claim/referral appeals and unauthorized claims, forwarding them for medical director/UMC review and determination when appropriate....

Estimated: $71,000 - $96,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

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DaVita Medical Group - Costa Mesa, CA

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

Estimated: $60,000 - $83,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

8d

Travelers - Diamond Bar, CA

Evaluate all claims for recovery potential; Actively participate in periodic file quality reviews. Directly handle the Company's most severe and complex claims....

Estimated: $71,000 - $99,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

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CalOptima - Orange, CA

The incumbent acts as a liaison with CalOptima’s claims vendors regarding data anomalies, claims editing, claims guidelines, feedback and identification of...

Estimated: $62,000 - $84,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

WellCare - Cypress, CA

Preferred Licensed Practical Nurse (LPN). Preferred Licensed Registered Nurse (RN) Technical Skills:. Intermediate Ability to create, review and interpret...

Estimated: $63,000 - $83,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

8d

Molina Healthcare - Long Beach, CA

Registered Nurse or BSN. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews....

Estimated: $63,000 - $82,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

UnitedHealth Group - Santa Ana, CA

Process retroactive reviews of claims. Perform chart reviews for Inpatient and SNF. Will aide in contacting patients and families, conduct chart reviews, and...

BB&T - Irvine, CA

Please review the following job description:. The Healthcare Data Analyst will be the subject matter specialist for analyzing medical and pharmacy claims and...

Estimated: $50,000 - $68,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

Conifer Health Solutions - Westminster, CA

JOB SUMMARY The purpose of the Utilization Management Nurse is to ensure quality of patient care, effective utilization of available health services, review of...

Conifer Health Solutions - Westminster, CA

Conifer Health Solutions is currently hiring for a full time RN Utilization Management Nurse. JOB SUMMARY The purpose of the Utilization Management Nurse is to...

Harbor Psychiatry & Mental Health - Orange County / Newport Beach - Newport Beach, CA

Review and update demographics and patient information for accuracy. Our health care professionals include top-trained psychiatrists, psychologists, psychiatric...

Estimated: $37,000 - $47,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

Disney Parks & Resorts - Anaheim, CA

Solid understanding of the State of California rules and regulations, the recent changes in the laws driven by recent reform including Utilization Review for...

Estimated: $60,000 - $85,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

Crawford & Company - Anaheim, CA

Coordinates IME’s and/or Physician Reviews as appropriate. Utilizes evidenced based medicine when performing claim reviews....

Estimated: $73,000 - $100,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

Harbor Psychiatry & Mental Health - Orange County / Newport Beach - Newport Beach, CA

Review and update demographics and patient information for accuracy. Our health care professionals include top-trained psychiatrists, psychologists, psychiatric...

Estimated: $34,000 - $44,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

Quality Health Strategies - Cerritos, CA

At least two years claims review experience required. Pre- and post-pay claims review and healthcare data experience preferred....

Estimated: $78,000 - $110,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

1d

TRISTAR Risk Management - Santa Ana, CA

Communicates with claimants, providers and vendors regarding claims issues. Conducts file reviews as scheduled by the client and management.*....

Estimated: $62,000 - $80,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

Travelers - Diamond Bar, CA

Manages litigated claims. Directly handle assigned severe claims. Actively engage in the identification, selection and direction of appropriate internal and/or...

Estimated: $53,000 - $69,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

9d

MEDEX - Newport Beach, CA

For the Utilization Review department, the UR/NCM staff assigns Workers’ Compensation utilization review requests;...

$15 - $18 an hour

HealthPRO®/Heritage - Tustin, CA

Responsible for conducting performance appraisals of all rehabilitation personnel, including collaboration and consultation with supervisory personnel to review...

Estimated: $69,000 - $97,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

The Children's Clinic - Long Beach, CA

Licensed Vocational Nurse:. Performs direct patient care as identified by Licensed Vocational Nurse Scope of Practice....

Estimated: $48,000 - $68,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

5d

Network Medical Management - Alhambra, CA

Extract and scan pertinent hospital records from CPSI (H&P, progress notes) for NP to review. Responsible for data collection to Assist PAC Nurse Practitioner...

Estimated: $32,000 - $44,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

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Care1st Health Plan - Monterey Park, CA

Contracting, Claims, Medicare Operations) to present reports and interact in meetings. Legal and Regulatory Services staff, Medical Management, Claims Staff as...

Estimated: $75,000 - $99,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

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Care1st Health Plan - Monterey Park, CA

Registered Nurse a plus. Eligibility review to ensure systems are set up in accordance with current eligibility documentation for the processing of claims....

Estimated: $91,000 - $120,000 a year

Please note that all salary figures are approximations based upon third party submissions to SimplyHired or its affiliates. These figures are given to the SimplyHired users for the purpose of generalized comparison only. Minimum wage may differ by jurisdiction and you should consult the employer for actual salary figures.

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