- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR...CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board ... II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 -… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Services As Needed / ... **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… 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 ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity… more
- Dignity Health (Santa Maria, CA)
- …Abilities, and Training** * Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used * Proficient in application of clinical ... **Responsibilities** **JOB SUMMARY / PURPOSE** Responsible for the review of medical records for appropriate admission status and continued hospitalization. Work… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/204105/case-manager%2c- rn utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April… 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
- Stanford Health Care (Palo Alto, CA)
- …years of experience as an RN - 3+ years of experience in case management/ utilization review Why work at Stanford Medicine | Stanford Health Care (SHC)? - ... Knowledge of principles and best practices of case management, utilization review , social work, care coordination and...to address them. **Licenses and Certifications** + Nursing / RN - Registered Nurse -… more
- UCLA Health (Los Angeles, CA)
- …+ experience in an HMO environment + Thorough knowledge of health care industry, utilization review , utilization management, and concurrent review ... all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team of UM coordinators and… 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...with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA)… more
- CVS Health (Sacramento, CA)
- …and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of residence. + 3+ years of Nursing ... experience. Preferred Qualifications + Prior authorization utilization management/ review experience preferred Outpatient Clinical experience. + Knowledge of… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established… more
- Molina Healthcare (Sacramento, CA)
- **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_3-12 NIGHT SHIFT: 7:30PM - 08:30AM PACIFIC HOURS NON EXEMPT, 3 days a week will rotate._** **_TRAINING SCHEDULE ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Inpatient/ Concurrent Review , Utilization Review / Utilization Management and… more
- Molina Healthcare (San Diego, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… more
- Molina Healthcare (Long Beach, CA)
- …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... medical clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse … more
- Select Medical (Los Angeles, CA)
- …Cedars, UCLA and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Registered Nurse ( RN ) or Social Worker (LCSW) **Per Diem** **Pay Rate: ... + Coordinates with other departments, ie: Pre-Admissions, Admissions, Patient Accounts, Utilization Review , PPS Coordinator, etc., to assure positive fiscal… more
- Sutter Health (Burlingame, CA)
- …: **EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire CCM certification ... and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of… more
- Sutter Health (Modesto, CA)
- …weekend **EDUCATION:** + Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire + BLS - ... and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Awareness of… more
- Sharp HealthCare (La Mesa, CA)
- …Status** Per Diem **Shift** Day **FTE** 0 **Shift Start Time** **Shift End Time** California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA...the department head as indicated. + Utilization review and utilization managementThe RN … more
- Sutter Health (San Francisco, CA)
- …+ Other: Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California + CCM - Certified Case Manager ... management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Working knowledge of… more
- CVS Health (Sacramento, CA)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... in a hospital setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more