- 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
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/228577/ rn -case-manager 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
- Molina Healthcare (Long Beach, CA)
- …**Required Experience** Minimum three years clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required ... Licensed Vocational Nurse (LVN) license in good standing. **Preferred Education** Registered Nurse . Bachelor's Degree in Nursing or Health Related Field… more
- Fresenius Medical Center (Pasadena, CA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Fresenius Medical Center (Newport Beach, CA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the...will be on care coordination communication and collaboration with utilization management nursing physicians ancillary departments insurers and post… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients… more
- Prime Healthcare (San Dimas, CA)
- …experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing… more
- STG International (Corona, CA)
- …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. ... patient safety. *Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health… more
- Elevance Health (Costa Mesa, CA)
- …of 3 years experience in quality improvement and/or behavioral health, risk management and/or utilization review in a managed care setting as well as process ... + Independently licensed behavioral health clinician preferred (LCSW, LPCC, LMFT, Ph.D., Psy.D., RN ). + Candidates from all states are welcome, but they must reside… more
- Amergis (Orange, CA)
- …help support a health insurance agency! The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for ... providers. The incumbent will be responsible for prior authorizations, concurrent review and related processes. Position Details: Location: Orange (Full Office, no… more
- Elevance Health (Cerritos, CA)
- …facility-based and outpatient professional treatment health benefits through telephonic or written review . **Primary duties may include but are not limited to:** + ... equivalent background. + Current active unrestricted license, such as RN LCSW LMSW LMHC LPC LBA (as allowed by...adapt to new technologies preferred. + Previous experience in utilization management with a broad range of experience with… more
- Elevance Health (Costa Mesa, CA)
- **Telephonic Nurse Case Manager II** **Sign on Bonus: $2000.** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more