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Kaiser PermanenteNew
Overview
Collaborate with physicians to optimize quality and efficiency of care for hospitalized members through daily utilization reviews and discharge planning. Coordinate seamless transitions of care by assessing patient needs and communicating with multidisciplinary teams and community agencies.
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Compensation
Salary not listed
Posted
New
L.A. Care Health Plan
Manage a caseload of complex and high-risk members by coordinating healthcare benefits and facilitating access to care. Collaborate with interdisciplinary teams and providers to develop member-centric care plans and promote wellness.
$88,854 - $142,166 / YEAR
2 days ago
NeueHealth
The Utilization Management Nurse evaluates and processes prior authorization requests for medical procedures, medications, and services to ensure clinical appropriateness. They also collaborate with medical directors and healthcare providers to facilitate coverage decisions and maintain compliance with regulatory standards.
$74,260 - $111,391 / YEAR
5 days ago
The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary referrals, ensuring timely determination and notification of referral statuses, and generates necessary approval or denial communications. This role also involves performing telephonic and/or onsite admission and concurrent review, collaborating on discharge plans, and monitoring inpatient admissions.
7 days ago
SolutionHealth
Assists providers with patient examinations, diagnostic studies, and the administration of medications and immunizations. Manages clinical documentation, patient rooming, and the processing of medical specimens and prescriptions.
8 days ago
The Medical Assistant/LPN will assist providers with patient examinations, diagnostic studies, and clinical procedures while maintaining accurate medical records. They are also responsible for managing clinical supplies, administering medications, and performing point-of-care testing in accordance with healthcare standards.
Duke Health
Responsible for all aspects of credentialing for medical providers within the Duke University Health System to ensure compliance with regulatory standards. This includes verifying practitioner information, maintaining credentialing databases, and managing renewals and applications.
Intermountain Health
Collaborate with healthcare teams to manage patients with chronic conditions through education, service coordination, and barrier resolution. Perform psychosocial assessments and develop care plans consistent with COP and NCQA standards.
$39 - $60 / HOUR
This role involves assisting providers in clinical areas with patient examinations, procedures, diagnostic studies, and treatment, while also performing general administrative duties compliant with regulatory standards. Key tasks include preparing visit charts, accurately performing rooming activities, obtaining vital signs, conducting specific screenings, and processing specimens.
This role involves assisting providers with patient care in clinical areas, including patient examinations, procedures, diagnostic studies, and dressing changes. Key duties also include performing comprehensive rooming activities and preparing visit charts based on scheduled appointments.
Prime Therapeutics
The Physician Clinical Reviewer provides timely medical review of service requests that do not meet initial medical necessity guidelines, routinely interacting with physicians and staff. Responsibilities include discussing determinations with requesting providers, providing clinical rationale for appeals, and ensuring consistency using medical review guidelines.
$91 - $154 / HOUR
The Physician Clinical Reviewer conducts timely medical reviews of service requests that do not meet initial necessity guidelines. They also provide clinical rationale for appeals and act as a resource for the utilization management team.
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, requiring routine interaction with physicians and management staff. Responsibilities include discussing determinations with requesting providers within regulatory timeframes and providing clinical rationale for standard and expedited appeals.
The Medical Assistant II assists providers in patient care, including examinations, procedures, and administrative duties. They are responsible for preparing visit charts, rooming patients, obtaining vital signs, and managing clinical supplies.
Memorial Hermann Health System
This role is responsible for the front-line coordination of system-wide credentialing, ensuring accurate and timely processing of provider applications, managing daily workflow, and preparing necessary documentation for committee meetings. Key accountabilities include coordinating department workflow, preparing audit information, attending committee meetings, and overseeing training related to credentialing tools.
10 days ago
This role is responsible for the front-line coordination of system-wide credentialing functions, ensuring accurate and timely processing of provider applications through daily workflow management and meeting preparation. Key accountabilities include coordinating department workflow, preparing audit information, attending committee meetings, and onboarding new staff regarding credentialing tools and procedures.
WellPower - All Jobs
Manage the credentialing and re-credentialing process for healthcare providers, interns, and volunteers to ensure regulatory compliance. Maintain accurate provider files and serve as a liaison between providers, insurance companies, and internal departments.
$57,803 - $80,995 / YEAR
UnitedHealth Group
Responsible for the credentialing and recredentialing of employed physicians and contracted affiliated providers. Duties include primary source verifications, maintaining files, and liaising with payors regarding audits and reports.
$18 - $32 / HOUR
14 days ago
Hoag
The UM Nurse determines the medical necessity of inpatient admissions and continued stays based on evidence-based guidelines. They are also responsible for reviewing incoming referrals and authorization requests for clinical appropriateness and standards of care.
$50 - $78 / HOUR
16 days ago
Establish person-centered care plans and coordinate services for members receiving long-term services and supports. Conduct home visits and collaborate with stakeholders to address social determinants of health and ensure quality care.
$29 - $52 / HOUR
17 days ago
