- The County of Los Angeles (Los Angeles, CA)
- …Considerable ambulation may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience ... OPTION II: Two (2) years of experience as a registered nurse , of which one year must...the County of Los Angeles, a Utilization Review Nurse is an RN ...Los Angeles, a Utilization Review Nurse is an RN that has Case… more
- 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 + Full Time - Evening ... **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
- Centene Corporation (Sacramento, CA)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …Per Hour RN /LCSW/LMFT/LPCC $54.00-64.00 Per Hour REPORTS TO: Director of Utilization Review DESCRIPTION OF POSITION: Work as member of multi-disciplinary ... and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: LVN/LPT $31.50-37.50...+ Current license as an LCSW, ASW, AMFT, LMFT, RN , LVN, LPT, or LPCC. + Preferred; Master's degree… more
- Dignity Health (Bakersfield, CA)
- …+ AHA BLS + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Proficient in application of clinical guidelines ... **Responsibilities** Responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/212260/case-manager%2c- rn utilization - ... 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
- Ventura County (Ventura, CA)
- Per Diem Registered Nurse II/III - Utilization Management VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply Per Diem ... Registered Nurse II/III - Utilization ...as needed to assist with patient care coordination and utilization review . The incumbent will be responsible… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating in ... System Utilization Management SUM Care Without Delay RN...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… 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
- Amergis (Rancho Cordova, CA)
- … Management. Apply today to learn more about the current opportunities! The Utilization Review Specialist is responsible for theassessment and review ... + Current license for the state in which the nurse practicesif nursing licensure is required by contract +...Degree in Nursing or at least two years'experience in Utilization Review preferred + Certification in … 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
- Molina Healthcare (San Jose, CA)
- California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_3-12 DAY SHIFT 7:30AM - 08:30PM PACIFIC HOURS NON EXEMPT, 3 days a week will ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual… 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
- 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 (Vallejo, CA)
- …+ Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** + ... 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)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... 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 (Tracy, CA)
- …+ Other: Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California + BLS-Basic Life Support Healthcare ... 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