- Prime Healthcare (Ontario, CA)
- …credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/176615/ utilization - review - nurse - lvn ... Self-Funded Plan. Qualifications Required qualifications: + Possess an active CA Licensed Vocational Nurse ( LVN ) license. + Minimum two years of experience in… more
- UCLA Health (Los Angeles, CA)
- …with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, or health plan ... and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial… more
- Amergis (Orange, CA)
- …experience, 1+ year in utilization management, prior authorization, or clinical nurse review + Preferred: LVN degree, Case Management Certification ... Salary: $20 / Hour LVN Medical Case Manager - Pre-Authorization Nurse Reviewer Amergis Healthcare is seeking an experienced LVN Medical Case Manager to… more
- Emanate Health (Covina, CA)
- …the United States, and the #19 ranked company in the country. **Job 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
- Molina Healthcare (Long Beach, CA)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... **JOB DESCRIPTION** **Job Summary** The **Delegation Oversight Nurse ** is responsible for ensuring that Molina Healthcare's...additional duties of the team. We are looking for LVN 's with at least 4 years of UM experience,… more
- UCLA Health (Los Angeles, CA)
- …patient records + Familiarity with the laws, rules, and regulations regarding utilization review and discharge planning of government programs such Medicare, ... care plans + Utilize evidence-based tools for risk stratification + Perform utilization reviews, including authorization reviews + Ensure delivery of concurrent and… more
- Molina Healthcare (Long Beach, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse ( LVN...social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital… more