Key Responsibilities
Review and document prior authorization and appeals requests, along with member case history
Analyze trends and recommend revisions to medical policies and utilization management based on case reviews
Interface with members, providers, and internal departments to ensure effe
Key Responsibilities:
Review prior authorization requests for medical necessity and collaborate with Medical Directors as needed
Utilize evidence-based criteria and governmental policies for medical necessity reviews and manage claims disputes
Coordinate transitions of care and referrals to Care
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Travel Nurse, Case Manager, Utilization Review, Healthcare, RN, Nursing Jobs, Medical Solutions, Flexible Schedule, High Pay, Personalized Compensation. The Travel Nurse RN - Case Manager, Utilization Review role involves providing high-quality nursing care while managing cases for patients during a
Key Responsibilities
Complete prior authorization and retrospective review of medical services
Refer cases to Medical Directors as necessary
Maintain knowledge of regulations and comply with internal policies
Required Qualifications
Active and unrestricted LVN license in California
Experienc
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