- Equiliem (Orange, CA)
- …the appropriate level of care based on medical necessity criteria. The Care Manager will review and process requests for authorization of BHT services from ... position such as those listed above may also be qualifying.Preferred Prior authorization/ utilization review experience. Managed care experience. Post degree ABA… more
- Prime Healthcare (Lynwood, CA)
- …licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/157925/case- manager -rn%2c-- utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the...Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing experience preferred.… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... to provide requested clinical and psychosocial information to assure reimbursement. UTILIZATION REVIEW + Reviews prospectively, concurrently and retrospectively… more
- Cedars-Sinai (Los Angeles, CA)
- …named us one of America's Best Hospitals! **What You Will Do in This Role:** The Utilization Review Case Manager validates the patient's placement to be at ... based on nationally accepted admission criteria. The UR Case Manager uses medical necessity screening tools, such... follows the UR process as defined in the Utilization Review Plan in accordance with the… more
- Sutter Health (Burlingame, CA)
- …the acute care patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to ... and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of… more
- Sharp HealthCare (San Diego, CA)
- …of the System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center ... and internal transfer requests and direct admission requests. This position supports utilization review functions to ensure appropriate patient status and… more
- Prime Healthcare (Montclair, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/175009/case- manager -%28rn%29 utilization ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the...Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing experience preferred.… more
- LA Care Health Plan (Los Angeles, CA)
- …Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review . Monitors and oversees the collection and transfer of ... Utilization Management Nurse Specialist LVN II Job Category:...workplace environment. Perform prospective, concurrent, post-service and retrospective claim medical review processes. Utilizing considerable clinical judgement,… more
- Prime Healthcare (National City, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/174432/case- manager utilization ... outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service… more
- LA Care Health Plan (Los Angeles, CA)
- …Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review . Monitors and oversees the collection and transfer of ... Utilization Management Nurse Specialist RN II Job Category:...inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff, physicians, providers, member/family… more
- HCA Healthcare (Campbell, CA)
- …years of experience in Managed Care, Provider Office, or Utilization Review organization required Physician Services Group ... Prepare and present authorization requests with supporting documentation for review with the Medical Director . Assume...personal growth, we encourage you to apply for our Utilization Management RN opening. We promptly review … more
- Evolent Health (Sacramento, CA)
- …and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager , Client ... mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point of contact for… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. Under the direction of the Utilization Management, Assistant Manager , you will play a key role in processing and ... requests + Process referrals and authorizations following established procedures within the medical group utilization department + Prepare and process referrals… more
- Molina Healthcare (Sacramento, CA)
- …to a 3 day/12 hour shift from then on._** **_Previous experience with Emergency Room Utilization Management / Utilization Review is required for this role. ... **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_PERMANENT SHIFT WILL BE :_** **_12...requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and… more
- Sharp HealthCare (La Mesa, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... or case management experience. + 3 Years case management, utilization review , care coordination experience. + California...communicates this to the care team.Refer defined cases for medical secondary review and share findings with… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... provides information to the department head as indicated. + Utilization review and utilization managementThe...communicates this to the care team.Refer defined cases for medical secondary review and share findings with… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... Health Care (SHC)? Are you a seasoned RN Case Manager ? Here is your opportunity to work with a...requested clinical and psychosocial information to assure reimbursement. + Utilization Review -- Reviews prospectively, concurrently and… more
- Alameda Health System (Oakland, CA)
- …clinical rounds and monthly audit of charts on care management activities ( utilization review , discharge planning and Interrater Reliability). -Prepares cost ... Manager , Care Management + Oakland, CA + Highland...consultant regarding care management issues; guides clinical staff with review of assessments and care plans, evaluates utilization… more
- Alameda Health System (Oakland, CA)
- …clinical rounds and monthly audit of charts on care management activities ( utilization review , discharge planning and Interrater Reliability). + Prepares cost ... Manager , Care Management + Oakland, CA + Highland...consultant regarding care management issues; guides clinical staff with review of assessments and care plans, evaluates utilization… more
- Sutter Health (Berkeley, CA)
- …and collaborates with interdisciplinary team to assure timely discharge. * Maintains an average Utilization Review (UR) accuracy rate at or above the goal. * ... and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Working knowledge… more
