- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW ... comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW ... and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- Dignity Health (Carmichael, CA)
- **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite Campus Position** The ** Utilization Review RN** is responsible for ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- Prime Healthcare (Ontario, CA)
- …licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/176615/ utilization - review - nurse ... Plan. Qualifications Required qualifications: + Possess an active CA Licensed Vocational Nurse (LVN) license. + Minimum two years of experience in acute hospital… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices....support and review of medical claims and utilization practices. Complete medical necessity and level of care… more
- Zurich NA (Sacramento, CA)
- AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking an AVP, Utilization Review & Pharmacy. This is a fully remote position, offering ... flexibility of a home-based office. As the AVP of Utilization Review & Pharmacy, you will lead...of experience in the Nursing areaAND + Registered Professional Nurse license in residential area and in operational national/local… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Evening + ... + Req #:41910-31048 + FTE:1 + Posted:May 22, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible for… more
- Providence (Mission Hills, CA)
- **Description** RN - Utilization Review for our centralized Utilization Management team for Southern California. This position is Remote (Working from Home ... candidates will reside/work in California. Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
- Prime Healthcare (Ontario, CA)
- …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patiens receive… more
- Dignity Health (Bakersfield, CA)
- …as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the adverse ... of defined levels of hierarchy and composition of compliant denial notices to review medical records, authorize requested services and prepare cases for physician … more
- Prime Healthcare (Montclair, CA)
- …effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service ... post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 years post… more
- Centene Corporation (Sacramento, CA)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more
- The Cigna Group (Sacramento, CA)
- …**Job Description Summary** Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate ... for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and impact of… more
- Veterans Affairs, Veterans Health Administration (San Francisco, CA)
- Summary The Patient Flow Utilization Management/ Utilization Review Consultant RN functions with advanced knowledge and skills to provide clinical ... with a collaborative, inter-disciplinary practice setting. Responsibilities The Patient Flow Utilization Management/ Utilization Review Consultant RN is… more
- Matrix Providers (Fairfield, CA)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... Registered Nurse - Disease Management Location: Fairfield, CA, United...facility treatment team referrals. Facilitates identification, adoption, implementation and utilization of standardized clinical practice guidelines and protocols for… more
- LA Care Health Plan (Los Angeles, CA)
- …and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The ... Payment Integrity Nurse Coder RN III Job Category: Clinical Department:...inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to… more
- The County of Los Angeles (Los Angeles, CA)
- …Please include the exam number and exam title. + Yes + No 08 NURSE PRACTITIONER CANDIDATE ASSESSMENT RATING FORMINSTRUCTIONS Review the four competency areas and ... an individual's ability to perform as based on core competencies for the nurse practitioner disciplines. Review and consider your resume, education, experience,… more
- The County of Los Angeles (Los Angeles, CA)
- …Please include the exam number and exam title. + Yes + No 08 NURSE PRACTITIONER CANDIDATE ASSESSMENT RATING FORMINSTRUCTIONS Review the four competency areas and ... an individual's ability to perform as based on core competencies for the nurse practitioner disciplines. Review and consider your resume, education, experience,… more